摘要
目的比较分析内镜黏膜切除术(EMR)、预切开EMR(EMR-P)、内镜黏膜下剥离术(ESD)和圈套器辅助ESD(ESD-S)4种内镜下切除方法治疗结直肠侧向发育型肿瘤(LSTs)的安全性和有效性。方法以2016年1月至2018年3月在解放军总医院第一医学中心接受内镜下治疗的146例结直肠LSTs病例为研究对象,回顾性分析患者基本信息、内镜下切除结果、术后组织病理学结果和随访结果。结果146例结直肠LSTs中,23例行EMR治疗,29例行EMR-P治疗,50例行ESD治疗,44例行ESD-S治疗。中位病变直径2.5 cm(1.2~10.0 cm)。EMR、EMR-P、ESD和ESD-S整块切除率分别为73.9%(17/23)、72.4%(21/29)、96.0%(48/50)、65.9%(29/44),差异有统计学意义(P<0.001);R0切除率分别为65.2%(15/23)、69.0%(20/29)、94.0%(47/50)、63.6%(28/44),差异有统计学意义(P=0.002)。ESD组整块切除率和R0切除率高于其他3组(P均<0.05)。4组术中穿孔率分别为0,0,6.0%(3/50),9.1%(4/44),差异无统计学意义(P=0.269);迟发性出血率分别为4.3%(1/23),0,2.0%(1/50),2.3%(1/44),差异无统计学意义(P=0.768)。117例(80.1%)患者术后进行了肠镜随访,中位随访时间10.0个月(3.0~26.0个月),其中局部复发7例(6.0%)。结论ESD是结直肠LSTs最理想的治疗方法;EMR可作为直径<20 mm结直肠LSTs的治疗方法;EMR-P和ESD-S作为改良的内镜下切除方法,在治疗LSTs上具有自身特殊的优势。
Objective To compare the efficacy and safety of endoscopic mucosal resection(EMR),EMR with pre-cutting(EMR-P),endoscopic submucosal dissection(ESD)and ESD with snare(ESD-S)for the treatment of colorectal laterally spreading tumors(LSTs).Methods Between January 2016 and March 2018,a total of 146 patients with 146 colorectal LSTs undergone endoscopic resection at the first medical center of PLA General Hospital.Data of demographics,treatment information,pathology and follow-up results were retrospectively analyzed.Results Among the 146 patients,EMR,EMR-P,ESD,and ESD-S were performed in 23,29,50 and 44 tumors,respectively.Median tumor diameter was 2.5 cm(ranged 1.2-10.0 cm).The en bloc resection rate of EMR,EMR-P,ESD and ESD-S were 73.9%(17/23),72.4%(21/29),96.0%(48/50),and 65.9%(29/44),respectively,with statistical difference(P<0.001).And the R0 resection rate were 65.2%(15/23),69.0%(20/29),94.0%(47/50),and 63.6%(28/44),respectively,with statistical difference(P=0.002).The en bloc resection rate and R0 resection rate of the ESD group were significantly higher than those of the other three groups(all P<0.05).The difference was not statistically significant in terms of perforation rate[0,0,6.0%(3/50),and 9.1%(4/44),respectively,P=0.269]and delayed hemorrhage rate[4.3%(1/23),0,2.0%(1/50),and 2.3%(1/44),respectively,P=0.768]among the four groups.Follow-up endoscopy was performed in 117 cases(80.1%)with a median period of 10.0 months(ranged 3.0-26.0 months),and local recurrence was identified in 7(6.0%)cases.Conclusion ESD could be the optimal method for the resection of colorectal LSTs,while LSTs smaller than 20 mm can be resected by EMR.EMR-P and ESD-S as modified methods have their respective advantages for the treatment of LSTs.
作者
邹家乐
柴宁莉
翟亚奇
王赞滔
王祥耀
李隆松
孟江云
杜红
令狐恩强
Zou Jiale;Chai Ningli;Zhai Yaqi;Wang Zantao;Wang Xiangyao;Li Longsong;Meng Jiangyun;Du Hong;Linghu Enqiang(Department of Gastroenterology,The First Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《中华消化内镜杂志》
CSCD
北大核心
2020年第3期169-173,共5页
Chinese Journal of Digestive Endoscopy
基金
国家重点研发计划(2016YFC1303601)。