内镜黏膜下剥离术治疗老年结直肠大面积侧向发育型肿瘤的临床研究

Clinical study of endoscopic submucosal dissection for large area of colorectal laterally spreading tumors in elderly patients

摘要:

目的 回顾性分析老年直径 ≥ 30 mm结直肠侧向发育型肿瘤（LST）的内镜下表现，并探讨内镜黏膜下剥离术（ESD）的治疗效果及随访情况。方法 回顾性分析2016年1月－2019年12月94例在该院行ESD治疗的直径 ≥ 30 mm结直肠LST患者的临床资料，其中老年组（ ≥ 60岁）49例，中青年组（30～59岁）45例。记录LST形态、部位、大小、ESD术后并发症、标本切除完整性、术后切缘情况和随访结果。结果 两组患者均顺利完成ESD整块切除手术。老年组结直肠LST的平均大小为（43.10±18.49）mm，中青年组LST的平均大小为（43.27±21.43）mm，两组病灶均以直肠多见，镜下类型以结节混合型（LST-G-NM）多发，两组病灶平均大小、LST分布及形态学比较，差异均无统计学意义（P > 0.05）。老年组7例术中穿孔（14.3%），3例术后并发出血（6.1%），中青年组1例术中穿孔（2.2%），2例术后并发出血（4.4%），两组并发症发生率比较，差异无统计学意义（P > 0.05）。两组术后病理均以低级别上皮内瘤变（LGIN）多见，老年组中1例切缘阳性（2.0%），中青年组5例切缘阳性（11.1%），两组术后病理及切缘情况比较，差异均无统计学意义（P > 0.05）。94例患者中86例完成术后随访，中位随访时间为21个月，无病灶残留或复发。结论 老年结直肠大面积LST的内镜下表现与中青年患者相似，ESD治疗老年结直肠大面积LST安全、有效，且中远期效果与中青年患者相当。

Abstract:

Objective This study retrospectively analyzed the endoscopic features of laterally spreading tumor (LST) with the size ≥ 30 mm in elderly patients and explore the efficacy and follow-up results of endoscopic submucosal dissection (ESD).Methods The clinical data of 94 patients with colorectal LST with diameter ≥ 30 mm treated with ESD from January 2016 to December 2019 were retrospectively analyzed, including 49 patients in the elderly group ( ≥ 60 years old) and 45 patients in the middle-young group (30 ~ 59 years old). The shape, location, size, complications after ESD, resection integrity of specimens, postoperative cutting edge and follow-up results were recorded.Results Patients in both groups successfully completed block resection of ESD. The average size of colorectal LST was (43.10 ± 18.49) mm in the elderly group and (43.27 ± 21.43) mm in the middle-young group respectively. Most of the lesions in the two groups were located in rectum and the morphology was nodular mixed. There was no significant difference in the average size, LST distribution and morphology between the two groups (P > 0.05). There were 7 cases of intraoperative perforation (14.3%) and 3 cases of postoperative bleeding (6.1%) in the elderly group. There was 1 case of intraoperative perforation (2.2%) and 2 cases of postoperative hemorrhage (4.4%) in the middle-young group. There was no significant difference in the incidence of complication between the two groups (P > 0.05). Postoperative pathology in both groups was mostly low grade intraepithelial neoplasia. There were 1 case of the incisal margin was positive in the elderly group (2.0%) and in 5 cases in the middle-young group (11.1%). There was no significant difference in postoperative pathology and incisal margin between the two groups (P > 0.05). Of the 94 patients, 86 completed postoperative follow-up, the median follow-up time was 21 months, there was no residual or recurrence of the lesions.Conclusion The endoscopic findings of large area colorectal LST in the elderly are similar to those in the middle-young patients. ESD is safe and effective in the treatment of large colorectal LST in elderly patients and the medium and long-term effects are comparable to those of and middle-young patients.