内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤的疗效

目的探讨直径〉2em的结直肠侧向发育型肿瘤（LST）的病理特点，评估内镜黏膜下剥离术（ESD）治疗结直肠LST的疗效及安全性。方法回顾性分析2007年12月至2011年4月复旦大学附属中山医院收治的151例结直肠LST患者的临床资料。根据内镜下表面形态将151例LST进行分型，统计各型LST的部位、大小、形态特征，然后对LST的临床病理特点以及ESD治疗的切除率、手术时问、并发症和复发情况进行分析。采用K系数检验分析LST亚型一致性。结果151例患者中，结直肠LST分布依次为：直肠58例、升结肠47例、盲肠15例、横结肠14例、乙状结肠13例、降结肠4例。病变直径为（3．4±1．2）em。颗粒型结直肠LST105例，其中结节混合型75例，颗粒均一型30例；非颗粒型结直肠LST46例，其中扁平隆起型31例，假凹陷型15例。两型分型一致系数K为0．87，四亚型分型一致系数K为0．80。腺瘤伴有低级别瘤变96例、高级别上皮内瘤变44例、黏膜下癌11例。腺瘤中管状绒毛状腺瘤58例、管状腺瘤33例、绒毛状腺瘤3例、锯齿状腺瘤2例。整块切除率为98．01％（148／151），完整切除率为94．70％（143／151），完整治愈切除率为90．73％（137／151）。手术时间为（52±31）min，ESD术后出血发生率为3．97％（6／151），穿孔发生率为3．31％（5／151）。平均随访时间为28．6个月，复发率为0．66％（1／151）。结论直径〉2cm的结直肠LST病变存在较高的恶变潜能。ESD治疗LST病变整块切除率高，复发率较低，是结直肠LST病变安全且有效的治疗方法。

Efficacy of endoscopic submucosal dissection for the treatment of colorectal laterally spreading tumor

Objective To investigate the clinicopatholgical features of colorectal laterally spreading tumor （LST） with a diameter 〉 2 cm, and assess the efficacy of endoscopic submucosal dissection （ESD） for the treat- ment of eolorectal LST. Methods The clinical data of 151 patients with eolorectal LST who were admitted to the Zhongshan Hospital from December 2007 to April 2011 were retrospectively analyzed. The distribution, size and morphological features of LST were recorded, and the clinieopathological data and resection rate, operation time, complications and recurrent rate of ESD were analyzed. The coherent rate of the LST subtype analysis was analyzed by the K correlation coefficient test. Results Colorectal LST mainly distributed in the rectum （58 cases）, and then followed by ascending colon （ 47 cases ） , cecum （ 15 cases ） , transverse colon （ 14 cases ） , sigmoid colon （ 13 cases） and descending colon （4 cases）. The diameter of the tumors was （ 3.4 ± 1.2） cm. There were 105 patients with LST-granular lesions, including 75 patients with nodular mixed type and 30 with homogenous type; 46 with LST-nongranular lesions, including 31 patients with elevated type and 15 with pseudodepressed type. The K value of the 2 types coherence was 0.87, and the s： value of 4 subtypes coherence was 0.80. There were 96 patients with low-grade neoplasia, 44 with high-grade intraepithelial neoplasia and 11 with submucosal neoplasia. Fifty-eight patients were with tubulovillous adenoma, 33 with tubular adenoma, 3 with villous adenoma, and 2 with serrated lesions. The en-bloc resection rate, complete resection rate and complete curative resection rate were 98.01% （ 148/151 ） , 94.70% （ 143/151 ） and 90.73% （ 137/151 ）, respectively. The operation time was （52 ± 31 ）minutes. The postoperative bleeding rate and perforation rate were 3.97% （6/151） and 3.31% （5/151） ,respectively. The mean time of follow-up was 28.6 months, and the recurrent rate was 0.66% （ 1/151 ）. Conclusions Colorectal LST with a diameter 〉 2 cm has higher potential for malignancy. ESD is safe and feasible for the treat- ment of colorectal LST with advantages of high resection rate and low recurrent rate.