结直肠侧向发育型肿瘤内镜下诊治的临床研究

  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。 

Clinical study on endoscopic diagnosis and treatment of laterally spreading tumor

  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.