中国实用外科杂志

中国实用外科杂志

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内镜黏膜下剥离术治疗直径≥2.5 cm结直肠息肉567例疗效分析

李    染，蔡世伦，孙    迪，钟芸诗，徐美东，周平红   

  1. 复旦大学附属中山医院内镜中心，上海200032
  • 出版日期:2019-02-01 发布日期:2019-01-31

  • Online:2019-02-01 Published:2019-01-31

摘要：

目的    评价内镜黏膜下剥离术（ESD）在治疗直径≥2.5 cm结直肠息肉中的价值。  方法    回顾性分析2007年1月至2016年11月复旦大学附属中山医院内镜中心接受ESD治疗的567例结直肠息肉（病变直径≥2.5 cm）病人的临床资料，分析其临床及病理特征、并发症和随访结果。  结果    病灶中位直径3.0（2.5～15.0）cm，其中448例（79.0%）为上皮内瘤变高级别，其余119例（21.0%）为腺瘤内腺癌、局灶癌变或腺癌；术中完整切除率为99.1%（562/567），大块切除（en bloc切除）率为78.3%（444/567），治愈性切除率为90.8%（515/567），其中31例在术后追加了外科或内镜治疗；术后出血并发症发生率为3.7%（21/567），术后穿孔发生率为1.2%（7/567），电凝综合征发生率为5.3%（30/567）；随访中位时间40（12～90）个月，原位复发率1.1%（6/536）。术中并发症的发生与病变直径≥5.0 cm（P<0.001）和非en bloc切除（P=0.034）有关，术后电凝综合征的发生与病变直径≥5.0 cm（P=0.004）相关，术后迟发性出血与高血压病史相关（P=0.008），原位复发与病变直径≥5.0 cm（P=0.037）有关。  结论    ESD治疗直径≥2.5 cm结直肠息肉是安全和可行的，可达到有效的治愈性切除，原位复发率极低。但直径≥5.0 cm结直肠息肉行ESD须慎重。

关键词: 结直肠息肉, 内镜黏膜下剥离术

Abstract:

Therapeutic effect analysis of colorectal polyps with diameter≥2.5cm treated by endoscopic submucosal dissection: A report of 567 cases        LI Ran, CAI Shi-lun, SUN Di, et al. Endoscopy Center，Zhongshan Hospital， Fudan University,Shanghai 200032,China
Corresponding author: ZHONG Yun-shi, E-mail：13564623481@126.com
Abstract    Objective    To evaluate the effectiveness of endoscopic submucosal dissection (ESD) in treating colorectal polyps with diameter≥2.5cm. Methods    The clinical data of 567 cases of colorectal polyps with diameter≥2.5cm treated by ESD at Endoscopy Center，Zhongshan Hospital，Fudan University between January 2007 and November 2016 were analyzed retrospectively. The data included clinical and pathological characteristics, complications and follow-up. Results    Of all lesions, the median diameter was 3.0cm (2.5 to 15.0). Among them, 448 lesions（79.0%） were high grade intraepithelial neoplasia, and the other 119 lesions （21.0%）were intra-adenoma adenocarcinoma, focal cancerization or adenocarcinoma. The complete resection rate during operation was 99.1% (562/567). The en bloc resection rate was 78.3% (444/567), and the curative resection rate was 90.8% (515/567). Additional surgeries or endoscopic treatment were performed in 31 cases after ESD treatment. Postoperative bleeding occurred in 3.7% (21/567) of all cases. Penetration and electrocoagulation syndrome after ESD occurred in 1.2% (7/567) and 5.3% (30/567) of cases respectively. The median length of follow-up was 40 (12-90) months, with a local recurrence rate of 1.1% (6/536). Intraoperative complications were related to lesions ≥5.0 cm (P<0.001) and non-en bloc resection (P=0.034). Electrocoagulation syndrome was related to lesions ≥5.0 cm (P=0.004). Postponed bleeding after ESD was related to hypertension (P=0.008). Local recurrence was related to lesions ≥5.0 cm (P=0.037). Conclusion    Treating colorectal polyps ≥2.5 cm with ESD is safe and feasible, resulting in high rate of curative resection and an extremely low local-recurrence rate. However, polyps≥5.0 cm showld be cautionly evaluated before ESD.

Key words: colorectal polyps, endoscopic submucosal dissection