结直肠侧向发育型肿瘤内镜治疗效果及术后迟发性出血的危险因素

Efficacy of endoscopic treatment oncolorectal laterally spreading tumor and risk factors of delayed bleeding after operation

目的评价结直肠侧向发育型肿瘤(LST)内镜治疗的效果,分析术后迟发性出血(DPPB)的危险因素。方法收集浙江大学医学院附属第二医院消化内科2015年1月至2020年12月因结直肠LST行内镜黏膜下剥离术(ESD)(ESD组)、预切开内镜下黏膜切除术(杂交ESD)(杂交ESD组)治疗的患者临床资料,比较ESD与杂交ESD的穿孔发生率、出血率、完整切除率、手术操作时间、病灶粘连情况;根据DPPB发生与否,将患者分为出血组与未出血组,通过多因素logistic回归模型分析DPPB可能的危险因素。结果共纳入665例结直肠LST患者,男376例,女289例,年龄(57.4±0.4)岁;行ESD 471例,杂交ESD 194例。两组患者性别、年龄、吸烟饮酒情况、高血压患病率差异均无统计学意义(均P>0.05);ESD组与杂交ESD组病灶粘连发生率(4.2%比7.7%,P=0.067)、病灶完整切除率(96.8%比93.8%,P=0.418)、穿孔率(0.6%比1.0%,P=0.594)、迟发性出血率(2.8%比2.1%,P=0.605)差异均无统计学意义。17例(2.6%)患者内镜治疗术后出现DPPB,多因素logistic回归分析结果显示,病灶部位在直肠(OR=3.594,95%CI:1.237~10.443,P=0.019)、病灶直径>2 cm(OR=3.776,95%CI:1.411~10.106,P=0.008)为DPPB的危险因素。结论ESD和杂交ESD术是结直肠LST治疗的有效手段。结直肠LST的病灶部位在直肠、病灶直径>2 cm是DPPB的危险因素。

Objective To evaluate the endoscopic treatment efficacy of colorectal laterally spreading tumor(LST)and analyze the risk factors for delayed post-polypectomy bleeding(DPPB).Methods Between January 2015 and December 2020,patients underwent colorectal endoscopic submucosal dissection(ESD)or hybrid ESD were recruited from the Second Affiliated Hospital of Zhejiang University.Complete resection rate,perforation rate,bleeding rate,operation time and lesion adhesion were compared between the ESD and hybrid ESD groups.Patients were divided into bleeding and non-bleeding groups based on the presence of DPPB.Multivariate logistic regression analysis was used to analyze the risk factors of DPPB.Results A total of 665 patients with colorectal LST were enrolled,including 376 males and 289 females,with an average age of(57.4±0.4)years.There were 471 cases underwent ESD and 194 cases underwent hybridized ESD.There were no significant differences in gender,age,history of smoking and drinking,and prevalence of hypertension between the two groups(all P>0.05).Likewise,the rate of lesion adhesion(4.2%vs 7.7%,P=0.067),lesion complete resection(96.8%vs 93.8%,P=0.418),perforation(0.6%vs 1.0%,P=0.594),delayed bleeding(2.8%vs 2.1%,P=0.605)were not statistically significant between the two groups.Seventeen patients(2.6%)developed DPPB after endoscopic treatment.Multivariate logistic regression analysis showed that the lesion was in the rectum(OR=3.594,95%CI:1.237-10.443,P=0.019)and the diameter of the lesion>2 cm(OR=3.776,95%CI:1.411-10.106,P=0.008)were risk factors for DPPB.Conclusions Both ESD and hybrid ESD are successful treatments for colorectal LST.Colorectal LST lesion site and lesion size>2 cm are risk factors of DPPB.