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内镜下切除结直肠侧向发育型肿瘤的临床结果研究 被引量:15

Endoscopic resection for colorectal laterally spreading tumors
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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)。
关键词 结直肠肿瘤 侧向发育型肿瘤 安全性 有效性 内镜下切除术 Colorectal neoplasm Laterally spreading tumor Safety Efficacy Endoscopic resection
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  • 1胡新云.联合使用内镜下黏膜剥离术和内镜下黏膜切除术治疗大肠侧向发育型肿瘤的效果观察[J].当代医药论丛,2014,12(12):250-251. 被引量:2
  • 2黄玮,吴云林.大肠侧向发育型肿瘤研究进展[J].中华消化杂志,2006,26(7):500-502. 被引量:12
  • 3Grgov S, Dugalic P, Tomasevic R, et al. Endoscopic mucosal re- section of flat and sessile colorectal adenomas: our experience with long-term follow-ups[ J]. Vojnosanit Preg1,2014,71 ( 1 ) :33- 38. 被引量:1
  • 4Iakovenko VO, Kuryk OH. The laterally spreading colon tumors. Diagnostic efficacy of colonoscopy and chromoscopy using indigo- carmine and acetic acid[J]. Kiln Khir,2013 ,11:21-23. 被引量:1
  • 5Tamura S, Nakajo K, Yokoyama Y, et al. Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors [ J ]. Endos- copy, 2004,36 ( 4 ) : 306 -312. 被引量:1
  • 6Wang J, Wang X, Gong W, et al. Increased expression of beta- catenin, phosphorylated glycogen synthase kinase 3beta, cyclin D1, and c-myc in laterally spreading colorectal tumors[ J]. J His- tochem Cytochem,2009,57(4) :363-371. 被引量:1
  • 7Kim KO, Jang BI, Jang WJ, et al. Laterally spreading tumors of the colorectum: clinicopathologic features and malignant potential by macroscopic morphology [ J ]. Int J Colorectal Dis, 2013,28 (12) : 1661-1666. 被引量:1
  • 8Kim BC, Chang H J, Han KS, et al. Clinicopathological differences of laterally spreading tumors of the colorectum according to gross appearance [ J ]. Endoscopy, 2011,43 ( 2 ) : 100-107. 被引量:1
  • 9Tanaka S, Haruma K, Oka S, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neo- plasms larger than 20 mm [ J ]. Gastrointest Endosc, 2001,54 ( 1 ) :62-66. 被引量:1
  • 10Lambert R, Tanaka S. Laterally spreading tumors in the colon and rectum [ J ]. Eur J Gastroenterol Hepatol, 2012, 24 ( 10 ) : 1123-1134. 被引量:1

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