内镜黏膜下剥离术治疗老年人大肠侧向发育型肿瘤的初步研究

Primary study of endoscopic submucosal dissection in treatment of colorectal laterally spreading tumor in elderly patients

摘要:

回顾性对比分析老年人与中青年人大肠侧向发育型肿瘤（LST）的临床病理特点，探讨内镜黏膜下剥离术（ESD）对老年人大肠侧向发育型肿瘤的治疗效果。方法 选取2011年9月－2016年9月在外院及该院检查发现，并在该院拟行ESD的LST患者，其中老年组（≥60岁）53例，中青年组（30～59岁）37例，比较老年组和中青年组的性别、病变形态分型、病变部位、病理类型、手术方法、平均住院时间及术后并发症等情况。结果 病变形态分型，老年人以结节混合型（LST-G-M）为主，与中青年组比较，差异有统计学意义（P <0.05）；中青年组以平坦隆起型（LST-NG-F）为主，与老年组比较，差异有统计学意义（P <0.05）；两组pit pattern分型，老年人以ⅢL型、Ⅳ型为主，青年组以Ⅱ型、ⅢL型为主，Ⅱ型两组比较，差异有统计学意义（P <0.05）；两组患者病变好发于直肠，尤其以老年组明显，与中青年组比较差异有统计学意义（P <0.05），其次是升结肠，其余均少见，左半结肠的发病率高于右半结肠；病理情况，老年组以管状绒毛状腺瘤为主，容易伴局部癌变，与中青年组比较差异有统计学意义（P <0.05）。结论 老年人LST是大肠癌发病的高危人群，若老年人检查发现LST，排除手术禁忌后应及时行内镜下切除；ESD是治疗大肠LST的重要手段，尤其适合老年人LST的治疗，值得临床运用与推广。

Abstract:

To analyze the clinicopathologic characteristics of colorectal laterally spreading tumor (LST) in elderly patients and explore the therapeutic effect of endoscopic submucosal dissection (ESD) in treatment of LST. Methods 90 cases of LST confirmed by colonoscopy from September 2011 to September 2016, and the patients were divided into two groups: elderly group (≥60 years old, n = 53) and young group (30 ~ 59 years old, n = 37). The gender, lesion type, the location of lesion, pathological type, surgical method, average hospitalization time and postoperative complications were retrospectively analyzed and compared between the two groups. Results The nodular-mixed type of LST in the morphology could be seen more in the elderly patients, whereas the flat elevate type of LST could be seen more in the young patients. There were significant differences between them (P < 0.05); The results from pit pattern classification showed that IIIL and IV types were main in the elderly patients and II and IIIL types were the main type in the young patients. There was significant difference in patients with II type between them (P < 0.05); The most of lesions were located in the rectum, especially in the elderly patients, and there was significant difference between the two groups (P < 0.05); Pathological analysis showed that tubule villous adenoma was seen more easily in the elderly than that in the young patients (P < 0.05), and the LST in the elderly patients had a higher risk to become cancer; ESD treatment for LST in the elderly patients was safe and effective.?Conclusion?The elderly patients with LST have high risk of colorectal cancer and it should be promptly resected by ESD. ESD is an important means for the treatment of LST. Especially suitable for the treatment of elderly LST, worthy of clinical application and promotion.