Department of Internal Medicine, Institute of Gastroenterology and Hepatology, Keimyung University School of Medicine, Daegu, South Korea.
Endoscopy. 2011 Jul;43(7):573-8. doi: 10.1055/s-0030-1256339. Epub 2011 Mar 29.
Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.
Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.
One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 - 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 - 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 - 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.
Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.
虽然穿孔是内镜黏膜下剥离术（ESD）治疗结直肠肿瘤的主要并发症之一，但穿孔的预测因素尚未得到充分评估。本研究旨在确定与结直肠 ESD 穿孔相关的因素。
纳入接受 ESD 治疗的结直肠肿瘤患者，回顾性分析其病历。年龄、性别、合并症、用药史、手术时间、切除方法、肿瘤大小、位置、大体形态、纤维化存在情况和组织学发现被纳入可能的危险因素。对穿孔发生的病例，分析与住院时间相关的因素。
108 例患者的 108 个病变符合纳入研究标准（68 例为男性；患者平均年龄为 63.01±10.71 岁）。平均肿瘤大小为 27.59±10.10mm（范围：8-53mm）。侧向扩展型肿瘤最常见（75%），其次为隆起型（25%）。手术时间为 61.95±41.90 分钟（范围：5-198 分钟）。85 个病变实现了完全整块切除（78.7%）。22 例患者（20.4%）发生穿孔。多因素分析证实，肿瘤大小[比值比（OR）：1.084；95%置信区间（CI）：1.015-1.158；P=0.017]和纤维化存在（OR：4.551；95%CI：1.092-18.960；P=0.037）是穿孔的独立危险因素。所有穿孔病例均采用非手术治疗。年轻和腹痛似乎与住院时间延长有关。
肿瘤大小和纤维化是结直肠 ESD 相关并发症的重要因素。年轻和腹痛的发生可以预测 ESD 后穿孔患者的住院病程。
