上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 短篇论著 • 上一篇    

内镜下黏膜切除术和黏膜剥离术治疗结直肠隆起性病变的对照研究

徐莹，蒯榕，李吉，杨大明，周锋利，金云菲，彭海霞   

  1. 上海市同仁医院  上海交通大学医学院附属同仁医院，上海 200336
  • 出版日期:2016-07-28 发布日期:2016-08-31
  • 通讯作者: 彭海霞, 电子信箱: haixiapeng@163.com。
  • 作者简介:徐莹（1987—）， 女， 住院医师， 博士; 电子信箱: xuyingjane@foxmail.com。

Comparative study on endoscopic mucosal resection and endoscopic submucosal dissection for the treatment of elevated colorectal lesions

XU Ying, KUAI Rong, LI Ji, YANG Da-ming, ZHOU Fen-li, JIN Yun-fei, PENG Hai-xia   

  1. Tongren Hospital, Shanghai Jiao Tong University School of Medicine， Shanghai 200336
  • Online:2016-07-28 Published:2016-08-31

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摘要：

目的 评估内镜下黏膜切除术（EMR）和内镜下黏膜剥离术（ESD）治疗结直肠隆起性病变的有效性和安全性，并分析影响EMR治疗后局部复发的危险因素，以改善EMR及ESD治疗的适应证。方法 回顾性总结427例（606枚）EMR治疗和70例（80枚）ESD治疗结直肠隆起性病变患者的临床及手术资料，并分析获得随访的145例EMR和30例ESD患者的临床及手术资料。比较2组在手术并发症、局部复发率方面的差异，分析EMR组中局部复发相关危险因素。结果 ESD组中手术并发症为7.14%（5/70），EMR组为2.58%(11/427)，2组在穿孔、大出血等并发症上的发生率无统计学差异（P=0.06）；EMR组的局部复发率为22.76%（33/145），明显高于ESD组3.33%（1/30）（P<0.05）。多因素分析结果提示，结直肠非单发病灶为EMR术后发生局部复发的危险因素。结论 虽然ESD的手术并发症发生率高于EMR，但可更完整地切除病灶，术后局部复发率也更低；对于存在结直肠多发病灶的患者，EMR治疗后需密切随访。

关键词: 内镜下黏膜切除术, 内镜下黏膜剥离术, 结直肠隆起性病变

Abstract:

Objective To evaluate the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the treatment of elevated colorectal lesions and analyze the risk factors for the local recurrence after EMR in order to improve the indications of EMR and ESD treatments. Methods The clinical and surgical data of 427 patients (with 606 colorectal lesions) undergoing EMR and 70 patients (with 80 colorectal lesions) undergoing ESD were retrospectively summarized. The clinical and surgical data of 145 patients undergoing EMR and 30 patients undergoing ESD obtained from follow-up visits were analyzed. The complications and local recurrence rates of two groups were compared and the risk factors for the local recurrence in the EMR group were analyzed. Results The rates of surgical complications in the ESD group and the EMR group were 7.14% (5/70) and 2.58% (11/427), respectively. There was no statistical difference in the rate of complications such as perforation and massive hemorrhage between two groups (P=0.06). The local recurrence rate of the EMR group was 22.76% (33/145), which was significantly higher than 3.33% (1/30) of the ESD group (P<0.05). The multiple factor analysis showed that multiple colorectal lesions were the risk factor for the local recurrence after EMR. Conclusion The rate of complications of ESD is higher than that of EMR with more complete resection of lesions and lower local recurrence rate. For patients with multiple colorectal lesions, close follow-up is required after EMR.

Key words: endoscopic mucosal resection(EMR), endoscopic submucosal dissection (ESD), elevated colorectal lesions