EMR在早期结直肠癌及高级别上皮内瘤变中的应用价值分析

EMR for early-stage colorectal cancer and high grade intraepithelial neoplasia

目的分析内镜下黏膜切除术(EMR)治疗早期结直肠癌及高级别上皮内瘤变(HGIN)的应用价值。方法回顾性分析2019年6月至2020年5月在中山大学附属第六医院行EMR治疗的144例早期结直肠癌或HGIN患者的临床资料,分析病灶病理特点,评估内镜治愈情况、术后并发症及复发情况。结果144例患者中:病灶部位,降结肠至直肠115例(79.9%)、横结肠13例(9%)、盲升结肠16例(11.1%);病灶形态,山田Ⅰ型(扁平型)/侧向发育型息肉9例(6.3%)、山田Ⅱ型(无蒂型)38例(26.4%)、山田Ⅲ型(亚蒂型)64例(44.4%)、山田Ⅳ型(有蒂型)33例(22.9%);病灶直径,内镜评估病灶直径5~40 mm,平均病灶直径(16.7±8.5)mm;病理类型,重度异型增生84例(58.3%)、原位癌18例(12.5%)、黏膜内癌37例(25.7%)、黏膜下癌5例(3.5%);病灶切除情况,133例(92.4%)病灶为整块切除,11例(7.6%)病灶为分片切除。142例实现治愈性切除,内镜切除成功率为98.6%;术中未出现并发症,3例(2.1%)患者术后出现并发症;74例(51.4%)患者获得有效随访,随访时间1~25个月,随访过程中无1例复发。结论EMR治疗早期结直肠癌及HGIN安全有效,在预防和干预结直肠癌发生、发展方面具有重要的应用价值。

Objectives To analyze the value of endoscopic mucosal resection(EMR)for early-stage colorectal cancer and high grade intraepithelial neoplasia(HGIN).Methods This was a retrospective analysis of 144 patients with early-stage colorectal can⁃cer and HGIN treated with EMR between June 2019 and May 2020 at the Sixth Affiliated Hospital of Sun Yat-sen University.Pathological characteristics of the lesions,the success rate of EMR,postoperative complications,and recurrence were analyzed.Results Of the 144 patients,the lesions were located between descending colon to rectum in 115(79.9%)patients,transverse colon in 13(9%),and cecum/ascending colon in 16(11.1%).In terms of morphology,9(6.3%)patients were Yamada typeⅠ(flat)/lateral spreading tumor,38(26.4%)Yamada were typeⅡ(sessile),64(44.4%)were Yamada typeⅢ(sub-pedunculated),and 33(22.9%)were Yamada typeⅣ(pedunculated).According to endoscopy,the diameter of the lesions ranged from 5 to 40mm with a mean(SD)of 16.7(8.5)mm.In terms of pathological types,84(58.3%)patients had severe dysplasia,18(12.5%)patients had carcinoma in situ,37(25.7%)patients had intramucosal carcinoma,and 5(3.5%)patients had submucosal carcinoma.En-bloc re⁃section was performed for 133(92.4%)lesions,and piecemeal resection for 11(7.6%)lesions.142 patients were cured with EMR.The success rate of EMR was 98.6%.There were no intraoperative complications.3(2.1%)patients experienced postoperative com⁃plications.74(51.4%)patients received effective endoscopic follow-up for 1 to 25 months,and no recurrence was reported during the follow-up.Conclusion EMR is effective and safe for early-stage colorectal cancer and HGIN.It shows important value in preventing and intervening the development and progression of colorectal cancer.