Yoshida N, Wakabayashi N, Kanemasa K, Sumida Y, Hasegawa D, Inoue K, Morimoto Y, Kashiwa A, Konishi H, Yagi N, Naito Y, Yanagisawa A, Yoshikawa T
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto 602-8566, Japan.
Endoscopy. 2009 Sep;41(9):758-61. doi: 10.1055/s-0029-1215028. Epub 2009 Sep 10.
Endoscopic submucosal dissection (ESD) for colorectal tumors is not generally recommended because of the technical difficulties and complications, including perforation. These aspects of ESD are thoroughly analyzed in our retrospective study.
We studied 105 colorectal tumors, from 100 patients, that were treated by ESD at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2008. We analyzed tumor size, operation time, rate of en bloc resection, and complications. In addition, we thoroughly investigated the cases of perforation.
The average tumor size was 30.4 mm; average operation time, 102 min; and rate of en bloc resection, 88.5 %. Perforation occurred in 10.4 % of the ESD procedures. Of the 11 perforations, 8 were detected during ESD and treated by clip closure during endoscopy, while 3 were evident only on subsequent routine computed tomography (CT); these were also managed conservatively. A case of postoperative hemorrhage was also observed.
ESD effectively achieved a high rate of en bloc resection. However, the perforation rate was substantial; hence, improvement in the ESD method is required. The outcomes of ESD, especially for early colorectal malignancies, need to be assessed further.
由于技术难度和包括穿孔在内的并发症，一般不推荐对结直肠肿瘤进行内镜黏膜下剥离术（ESD）。我们的回顾性研究对ESD的这些方面进行了全面分析。
我们研究了2005年至2008年期间在京都府立医科大学或奈良市立医院接受ESD治疗的100例患者的105个结直肠肿瘤。我们分析了肿瘤大小、手术时间、整块切除率和并发症。此外，我们对穿孔病例进行了全面调查。
肿瘤平均大小为30.4毫米；平均手术时间为102分钟；整块切除率为88.5%。ESD手术中穿孔发生率为10.4%。在11例穿孔中，8例在ESD过程中被发现并在内镜检查时用夹子封闭治疗，而3例仅在随后的常规计算机断层扫描（CT）中才明显；这些也采用保守治疗。还观察到1例术后出血病例。
ESD有效地实现了较高的整块切除率。然而，穿孔率相当高；因此，需要改进ESD方法。ESD的结果，尤其是对早期结直肠恶性肿瘤的结果，需要进一步评估。
