早期结直肠癌患者ESD治疗前行超声内镜联合放大内镜检查的应用价值

Application value of ultrasonic endoscopy combined with magnification endoscopy before ESD treatment in patients with early colorectal cancer.

目的研究早期结直肠癌患者内镜下黏膜剥离术(ESD)治疗前行超声内镜与放大内镜联合检查的应用价值。方法采用回顾性分析方法,以2018年1月至2021年1月山西省临汾市中心医院和山西医科大学第二附属医院收治的98例早期结直肠癌患者为观察对象,所有患者均接受ESD治疗,根据ESD治疗前是否进行检查分为研究组(49例)与对照组(49例);研究组ESD治疗前行超声内镜联合放大内镜检查,对照组直接行ESD治疗。比较两组患者的ESD治疗情况及ESD疗效(再次ESD/外科手术率、治愈性切除率、非治愈性切除率)。结果(1)ESD治疗情况。研究组2例患者行超声内镜联合放大内镜检查显示不符合ESD治疗指征,转为外科手术进行治疗;47例患者接受ESD治疗,手术过程中无1例患者中转外科手术,1例患者手术过程中出现穿孔于内镜下处理成功闭合,1例患者术后延迟出血于内镜下处理成功止血,手术过程中无1例患者出现急性大量出血;2例患者术后非治愈性切除,其中1例再次接受ESD治疗,1例接受外科手术治疗。对照组1例患者ESD治疗过程出现较大穿孔及内镜下无法闭合中转外科手术治疗,1例由于病变基底部广基抬举阴性及粘连严重中转外科手术治疗,手术过程中无1例患者出现急性大量出血;5例患者术后非治愈性切除,其中1例再次接受ESD治疗,4例接受外科手术治疗。(2)ESD疗效。研究组再次ESD或外科治疗率、ESD非治愈性切除率为2.04%、2.04%,明显低于对照组(16.33%、18.37%),ESD治愈性切除率为97.96%,明显高于对照组(81.63%),差异均有统计学意义(P<0.05)。结论早期结直肠癌患者ESD治疗前行超声内镜联合放大内镜检查可对其ESD治疗指征做出准确评估,以提高治愈性切除率,降低患者术后再次ESD或外科手术治疗率与非治愈性切除率,提升ESD治愈性切除率。

Objective To study the application value of combined ultrasound endoscopy and magnification endoscopy before endoscopic mucosal dissection(ESD)in patients with early colorectal cancer.Methods A retrospective analysis method,A total of 98 patients with early-stage colorectal cancer who were admitted to Linfen Central Hospital and the Second Affiliated Hospital of Shanxi Medical University from January 2018 to January 2021 were the subjects of observation.All patients were treated with ESD,divided into study group(49 cases)and control group(49 cases)according to whether the examination was performed before ESD treatment or not.In the study group,ultrasound endoscopy combined with magnification endoscopy was performed before ESD treatment,while in the control group,ESD treatment was performed directly.ESD treatment and ESD efficacy(reESD/surgical rate,curative resection rate and non-curative resection rate)were compared between the two groups.Results(1)ESD treatment.In the research group,2 patients underwent endoscopic ultrasonography combined with magnifying endoscopy showed that they did not meet the indications for ESD treatment,and were converted to surgery for treatment;47 patients received ESD treatment.During the operation,no patient was converted to surgery,and 1 patient During the operation,the perforation was successfully closed under the endoscopic treatment,and 1 patient had delayed bleeding after the operation and successfully stopped the bleeding under the endoscope.During the operation,no patient had acute massive bleeding;2 patients underwent non-curative resection,One of them received ESD again,and one received surgery.In the control group,1 patient had a large perforation and could not be closed under the endoscope and was converted to surgery during ESD treatment,and 1 patient was converted to surgery due to negative base lift and severe adhesion.Massive bleeding;postoperative non-curative resection in 5 patients,of which 1 underwent ESD again and 4 underwent surgery.(2)ESD efficacy.The rate of repeat ESD or surgical treatment and the rate of non-curative resection of ESD in the study group were 2.04%,2.04%,which were more lower than those in the control group(16.33%,18.37%),and the rate of curative resection of ESD was 97.96%,which was significantly higher than that of the control group(81.63%),the differences were statistically significant(P<0.05).Conclusion Endoscopic ultrasonography combined with magnifying endoscopy before ESD treatment in patients with early-stage colorectal cancer can accurately evaluate the indications for ESD treatment,so as to improve the curative resection rate and reduce the postoperative recurrence rate of ESD or surgical treatment and non-curative treatment.The curative resection rate of ESD is improved.