结直肠侧向发育型肿瘤内镜下诊治的临床研究

胡红娜; 章礼久; 宋莎莎

doi:10.16766/j.cnki.issn.1674-4152.001995

结直肠侧向发育型肿瘤内镜下诊治的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.001995

1.
安徽医科大学第二附属医院消化内科，安徽合肥 230601
2.
安徽医科大学公共卫生学院流行病与卫生统计学系，安徽合肥 230032

基金项目:

2017年安徽省自然科学基金 1708085QH192

详细信息

通讯作者:
章礼久, E-mail: zhanglijiu6336@163.com

中图分类号: R735.3 R730.56
计量
- 文章访问数: 87
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-18
- 网络出版日期: 2022-02-16

Clinical study on endoscopic diagnosis and treatment of laterally spreading tumor

1.
Department of Gastroenterology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China

摘要

摘要: 目的研究结直肠侧向发育型肿瘤(laterally spreading tumor, LST)的内镜病理特征及内镜下治疗方法。方法回顾性分析安徽医科大学第二附属医院2014年1月—2019年12月经内镜诊断并行内镜下治疗的48例LST患者的临床病理资料。按病变部位将其分成直肠组(27例)和结肠组(21例)，分别记录直径大小、病变亚型及术后病理结果。27例行内镜下黏膜剥离术(endoscopic submucosal dissection，ESD)，19例行内镜黏膜下剥离术(endoscopic mucosal resection，EMR)/内镜下分片黏膜切除术(endoscopic piece mucosal resection，EPMR)，另有2例行预切开的黏膜切除术(pre-cut-endoscopic mucosal resection，Pre-cut-EMR)，观察内镜下治疗的残留率、出血率、穿孔率及复发率。结果 2组患者年龄、性别差异无统计学意义(均P > 0.05)。直肠组中，病变直径为(3.27±1.29)cm，以结节混合型为主；结肠组直径为(2.61±0.78)cm，以颗粒均一型为主，差异均有统计学意义(均P < 0.05)。直肠组中高级别上皮内瘤变和癌变比例相比结肠组明显升高(P < 0.05)。直肠LST以ESD治疗为主(74.1%)，结肠LST主要采用EMR/EPMR法(61.9%)。1例结肠LST因病灶长径过长无法行ESD有效完整切除，转外科手术，余47例均完整切除。1例术后出血(2.1%)，再次内镜下止血治疗好转。1例术后4年复发，并再次内镜下完整切除。本组患者均无残留、穿孔并发症。结论直肠LST病变范围较大，以结节混合型为主，具有相对较高的恶性潜能，以ESD治疗为主；结肠LST以颗粒均一型多见，多采用EMR/EPMR治疗，部分患者可考虑行pre-cut-EMR治疗。
- 侧向发育型肿瘤 /
- 内镜病理特征 /
- 内镜下诊治技术
Abstract: Objective To study the endoscopic pathological features and endoscopic treatment method of laterally spreading tumor (LST). Methods The clinic pathological data of 48 LST patients diagnosed and treated with endoscopy in the Second Affiliated Hospital of Anhui Medical University from January 2014 to December 2019 were retrospectively analyzed. According to the lesion site, the patients were divided into the rectal group (27 cases) and the colon group (21 cases), and their diameters, lesion subtypes and postoperative pathological Results were recorded respectively. Twenty-seven cases underwent endoscopic mucosal dissection (ESD), 19 cases underwent endoscopic mucosal resection (EMR/EPMR), and 2 cases underwent expected mucosal resection (pre-cut-off EMR). The residual rate, bleeding rate, perforation rate and recurrence rate of endoscopic treatment were observed. Results There was no significant difference in age and gender between the two groups (all P > 0.05). In the rectal group, the diameter of the lesions was (3.27±1.29) cm, and the nodules were mainly of mixed type, while in the colon group the diameter was (2.61±0.78) cm, and the main particles were all of the homogeneous type, with statistically significant differences (all P < 0.05). Compared with the colon group, the proportion of high-grade intraepithelial neoplasia and cancerization in the rectal group was significantly increased (P < 0.05). Rectal LST was mainly treated with ESD (74.1%), while colon LST was mainly treated with EMR/EPMR (61.9%). One case of colon LST was unable to receive effective complete resection with ESD due to excessive length of lesion length, and was transferred to surgical operation. The remaining 47 cases were all completely removed. Postoperative hemorrhage in 1 case (2.1%) was improved by endoscopic hemostasis therapy again. One patient recurred 4 years after operation and underwent complete endoscopic resection again. None of the patients in this group had residual or perforation complications. Conclusion Rectal LST lesions have a large range, mainly nodular mixed type, with relatively high malignant potential, mainly ESD therapy. Colonic LST is commonly treated with granular homogeneous type, and EMR/EPMR treatment is more common. Pre-cut-EMR treatment may be considered in some cases.
- Laterally spreading tumor /
- The endoscopic pathological features /
- Endoscopic diagnosis and treatment techniques

HTML全文

图 1 直肠ESD

注：A为内镜分型LST-GM，B为靛胭脂染色后边界清晰，C为病灶周边黏膜切开，D为金属夹封闭创面。

下载: 全尺寸图片幻灯片

图 2 结肠EPMR

注：A为内镜分型LST-GH，B为靛胭脂染色后边界清晰，C为EPMR法切除后创面，D为金属夹封闭创面。

下载: 全尺寸图片幻灯片

表 1 2组LST患者内镜及病理特征比较

组别	例数	直径(x±s，cm)	内镜分型[例(%)]				HGIN+癌变[例(%)]
组别	例数	直径(x±s，cm)	LST-GM	LST-GH	LST-FE	LST-PD	HGIN+癌变[例(%)]
直肠组	27	3.27±1.29	18(66.7)	2(7.4)	6(22.2)	1(3.7)	9(33.3)
结肠组	21	2.61±0.78	6(28.6)	11(52.4)	4(19.0)	0(0.0)	1(4.8)
统计量		2.195^a					4.243^c
P值		0.034	0.002^b				0.039
注：^a为t值，^b为采用Fisher精确检验，^c为χ²值。

下载: 导出CSV

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