内镜黏膜下剥离术治疗老年早期大肠癌及高级别上皮内瘤变患者的效果评价

Evaluation of endoscopic submucosal dissection in the treatment of early stage colorectal cancer and high-grade intraepithelial neoplasia in the elderly

目的:探讨老年早期结直肠癌和高级别上皮内瘤变(HGIN)患者接受内镜黏膜下剥离术(ESD)治疗的安全性和有效性。方法:收集2021年1月至2021年12月在温州医科大学附属第一医院接受ESD治疗的157例早期大肠癌和HGIN患者。根据年龄分为老年组(≥60岁,91例)和中青年组(18~59岁,66例)。比较老年组和中青年组患者的一般情况、病灶特点、手术情况、术后并发症等。结果:成功完成ESD术者156例,切除失败1例,后转外科。老年组病灶最大径为[2.5(1.7,3.5)cm],中青年组病灶最大径平均为[2.0(1.5,2.6)cm],差异有统计学意义(P<0.05)。老年组病变特别好发于直肠,与中青年组比较差异有统计学意义(P<0.05)。老年组术后并发症发生率高于中青年组,差异有统计学意义(P<0.05)。两组整块切除率、完整切除率、复发率差异无统计学意义(P>0.05)。结论:对于老年患者早期结直肠癌和HGIN的治疗,ESD是安全有效的方法;老年患者病灶较大,术后并发症较多,需多加重视。

Objective:To investigate the safety and efficacy of endoscopic submucosal dissection(ESD)in the treatment of early-stage colorectal cancer and high-grade intraepithelial neoplasia(HGIN)in the elderly.Methods:Clinical data of 157 patients with early-stage colorectal cancer and HGIN who received ESD treatment in the First Affiliated Hospital of Wenzhou Medical University from January 2021 to December 2021 were retrospectively analyzed.According to age,they were divided into the elderly group(≥60 years old,91 cases)and the young group(18-59 years old,66 cases).The baseline characteristics,lesion characteristics,success rate of operation,the time of operation and postoperative complications were compared between the two groups.Results:With only one patient who failed in the dissection and was transferred to surgery 156 patients received successful ESD.The maximum diameter of lesions was[2.5(1.7,3.5)cm]in the elderly group and[2.0(1.5,2.6)cm]in the young group,showing statistical difference(P<0.05).The lesions in the elderly group were more likely to occur in the rectum,with significant difference(P<0.05).The incidence of postoperative complications in the elderly group was higher than that in the young group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the en bloc resection rate,complete resection rate and recurrence rate(P>0.05).Conclusion:ESD is a safe and effective therapy in the treatment of early-stage colorectal cancer and HGIN in elderly patients,who need more care for their larger lesions and higher postoperative complication rate,compared with the young patients.