内镜下黏膜剥离术治疗累及肛门齿状线直肠病变的临床效果评价

The effect assessment of endoscopic submucosal dissection for rectal lesion extending to the dentate line

目的评价内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)在治疗累及肛门齿状线的直肠病变中的临床治疗效果。方法回顾性收集了2015年10月至2021年2月在首都医科大学附属北京友谊医院行ESD治疗的累及肛门齿状线的直肠病变患者30例。收集患者的年龄、性别、病变形态及病变大小等基线数据。通过分析操作时间、整块切除率、完全切除率、并发症及随访情况评价其安全性和有效性。结果30例病变的平均操作时间为(89.83±49.55)min,整块切除率为93.0%(28/30),完全切除率为90%(27/30)。术后病理结果:腺瘤23例(其中低级别腺瘤7例,高级别腺瘤16例),黏膜内癌6例,黏膜下腺癌1例(SM2期)。并发症:术中出现穿孔3例,术后出血4例,均予结肠镜下治疗好转。30例患者平均随访(3.33±1.44)年,随访期间未出现复发、肠腔狭窄及排便困难等并发症。结论应用ESD治疗累及齿状线的直肠病变安全、有效。

Objective To investigate the feasibility of endoscopic submucosal dissection(ESD)in rectal lesions extending to the dentate line.Methods The clinical data of 30 patients who underwent ESD in Beijing Friendship Hospital from October 2015 to February 2021 because of the rectal lesions extending to the dentate line were collected retrospectively in this study.Clinical characteristics including age,gender,lesion morphology,and lesion size were collected to illustrate the base lines of patients.The safety and effectiveness of ESD were accessed by analyzing procedure time,En bloc resection rate,complete resection rate,adverse events and recurrences rate of these patients.Results The mean procedure time of ESD was(89.83±49.55)min,En bloc resection rate was 93.0%(28/30),and complete resection rate was 90%(27/30).Histopathologic examinations of the resection samples showed that 23 cases of adenoma(7 cases of low-grade intraepithelial neoplasia and 16 cases of high-grade intraepithelial neoplasia),6 cases of intramucosal adenocarcinoma,and 1 case of submucosal adenocarcinoma(SM2)were included in these patients.About the complication of ESD,perforation occurred in 3 cases and delayed bleeding occurred in 4 cases.All complications were successfully resolved under endoscopy management.The average follow-up time was(3.33±1.44)years.No recurrences,anal stenosis and defecation difficulties events were observed during the follow-up period in all patients.Conclusion As a minimal invasive way for curable treatment,ESD is safe and feasible for rectal lesions extending to the dentate line.