内镜黏膜下剥离术治疗巨大结直肠侧向发育型肿瘤的临床研究

Outcomes of endoscopic submucosal dissection for colorectal large laterally spreading tumors

摘要:

目的 评价内镜黏膜下剥离术（ESD）治疗巨大结直肠侧向发育型肿瘤（LST）中的疗效和安全 性。方法 对150 例病灶直径>4 cm 的结直肠LST 的临床资料进行回顾性总结，分析LST 形态分型、部位、 病理结果、整块切除率、完全切除率和并发症。结果 150 例患者中，颗粒型87 例（58.0%），非颗粒型63 例 （42.0%）。部位分别为直肠109 例（72.7%），乙状结肠13 例（8.7%），降结肠5 例（3.3%），横结肠8 例（5.3%）， 升结肠13 例（8.7%），盲肠2 例（1.3%）。低级别上皮内瘤变23 例，高级别上皮内瘤变104 例，黏膜内癌7 例， 黏膜下癌16 例。整块切除率为92.7%（139/150），完全切除率89.3%（134/150）。术中出血8.0%（12/150），术 后出血1.3%（2/150），穿孔率为2.0%（3/150），术后狭窄2.0%（3/150）。结论 非颗粒型巨大结直肠LST 恶变 率大。ESD 治疗巨大结直肠LST 是安全有效的。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection for the treatment of colorectal large laterally spreading tumor. Methods ESD was applied to treat 150 cases of colorectal LST with diameter larger than 4 cm. The morphological features of LST, distribution, the clinicopathological data and the enbloc resection rate, complete resection rate, complications were retrospectively evaluated. Results There were 87 patients with LST-granular lesions and 63 patients with LST-nongranular lesions. Colorectal LST mainly distributed in the rectum for 109 cases (72.7%), sigmoid colon for 13 cases (8.7%), descending colon for 5 cases (3.3%), transverse colon for 8 cases (5.3%), ascending colon for 13 cases (8.7%), cecum for 2 cases (1.3%). There were 23 patients with low-grade neoplasia, 104 patients with high-grade intraepithelial neoplasia, 7 with intramucosal carcinoma and 16 with submucosal carcinoma. The en-bloc resection rate and complete resection rate were 92.7% (139/150) and 89.3% (134/150). Adverse events were intra-operative bleeding in 12 patients (8.0%), postoperative bleeding in 2 patients (1.3%), perforation in 3 patients (2.0%), postoperative stenosis in 3 patients (2.0%). Conclusion Colorectal large LST-NG has higher potential for malignancy. ESD is a safe and effective method to provide en-bloc and complete resection of colorectal large LST.