Gastroenterology, Toranomon Hospital, Tokyo, Japan.
J Gastroenterol Hepatol. 2010 Nov;25(11):1747-53. doi: 10.1111/j.1440-1746.2010.06331.x.
Residual or locally recurrent lesions may occur after endoscopic therapy for epithelial colorectal tumors. Additional endoscopic mucosal resection is difficult for large lesions. Endoscopic submucosal dissection may be useful for such lesions, but may be more technically difficult for residual/locally recurrent lesions than for primary lesions. This study evaluated the efficacy of endoscopic submucosal dissection for residual/locally recurrent lesions in comparison with primary lesions.
This retrospective case-control investigated 34 residual/locally recurrent lesions and 384 primary lesions treated using endoscopic submucosal dissection. Tumor size, resected specimen size, procedure duration, en bloc resection rate, curative resection rate, histology, associated complications, and recurrence rate were compared between groups.
Procedure duration tended to be longer (85 ± 53 min vs 73 ± 55 min) and tumors were significantly smaller (20 ± 13 mm vs 33 ± 20 mm; P < 0.001) in the residual/locally recurrent group, compared with primary lesions. Both groups showed similar percentages of en bloc (100% vs 97.4%) and curative resection (88.4% vs. 83.6%). Perforation rate was significantly higher in the residual/locally recurrent group (14.7% vs 4.4%, P < 0.05). However, emergency surgery was only needed in 1 of 5 cases in the residual/locally recurrent group, with the remaining 4 cases conservatively managed using endoclips.
Endoscopic submucosal dissection for residual/locally recurrent lesions was curative and efficacy. This procedure could help to avoid surgical resection and frequent follow-up examinations in many patients.
上皮性结直肠肿瘤内镜治疗后可能残留或局部复发病变。对于大病变，再次进行内镜下黏膜切除术较为困难。内镜黏膜下剥离术对于此类病变可能有用，但对于残留/局部复发病变，其难度可能大于原发性病变。本研究评估了内镜黏膜下剥离术治疗残留/局部复发病变的疗效，并与原发性病变进行了比较。
本回顾性病例对照研究调查了 34 例残留/局部复发病变和 384 例接受内镜黏膜下剥离术治疗的原发性病变。比较两组的肿瘤大小、切除标本大小、手术时间、整块切除率、治愈性切除率、组织学、相关并发症和复发率。
与原发性病变相比，残留/局部复发病变的手术时间较长（85 ± 53 分钟 vs 73 ± 55 分钟），肿瘤明显较小（20 ± 13 毫米 vs 33 ± 20 毫米；P < 0.001）。两组的整块切除率（100% vs 97.4%）和治愈性切除率（88.4% vs. 83.6%）相似。残留/局部复发病变组穿孔率显著较高（14.7% vs 4.4%，P < 0.05）。然而，残留/局部复发病变组仅 1 例（14.7%）需要紧急手术，其余 4 例（44.4%）通过内镜夹保守治疗。
内镜黏膜下剥离术治疗残留/局部复发病变是有效的。该方法可以帮助避免手术切除和许多患者频繁的随访检查。
