内镜黏膜下剥离术治疗结直肠黏膜下肿瘤的疗效分析

目的探讨结直肠黏膜下肿瘤的诊断及内镜黏膜下剥离术(ESD)治疗的疗效和安全性。方法收集2011年1月-2017年1月在该院消化内镜中心行ESD治疗的结直肠黏膜下肿瘤的患者67例,病灶68处,进行回顾性分析。结果 68处病灶中,神经内分泌肿瘤占61.8%,以直肠分布为主,脂肪瘤占29.4%,以结肠分布为主;超声内镜检查46处病灶,位于黏膜下层38处(82.6%),低回声31处(67.4%)。ESD治疗病灶整块切除率100.0%,病理完整切除率94.1%;并发症情况:穿孔发生率6.0%,术后出血发生率1.5%,无1例需外科手术干预;术后随访率95.5%,中位随访时间33个月(3~75个月),未见复发及远处转移。结论超声内镜有助于结直肠黏膜下肿瘤的诊断,ESD治疗结直肠黏膜下肿瘤安全、有效。

Efficacy of endoscopic submucosal dissection for colorectal submucosal tumors

Abstract: Objective To evaluate the outcomes and safety of ESD in colorectal SMTs. Methods Between January 2011 and January 2017, we performed ESD on 68 consecutive colorectal SMTs in 67 patients. We evaluated the clinical outcomes of all said cases. Results The most common type of the 68 colorectal SMTs was neuroendocrine tumor (42/68, 61.8%), followed by lipoma (20/68, 29.4%). Most of neuroendocrine tumors (41/42) were located in rectum, and most of lipomas (18/20) were located in colon. Among the 46 tumors which were evaluated by endoscopic ultrasonography (EUS) before ESD,38 tumors (82.6%) were located in the submucosal layer, and 31 tumors (67.4%) were hypoecho. Our overall endoscopic en bloc resection rate was 100.0%, and our R0 resection rate was 94.1% respectively. Our perforation rate of ESD was 6.0%, delayed bleeding rate 1.5%. None of the patients need surgical intervention because of complication. Follow-up rate was 95.5%, no recurrence or metastasis was observed during the median follow-up period 33 months (range 3~75 months). Conclusion EUS is conductive to the diagnosis of colorectal SMTs before ESD. ESD is a safe and effective treatment for colorectal SMTs.