Ohata Ken, Nonaka Kouichi, Minato Yohei, Misumi Yoshitsugu, Tashima Tomoaki, Shozushima Meiko, Mitsui Takahiro, Matsuhashi Nobuyuki
Division of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
J Oncol. 2013;2013:218670. doi: 10.1155/2013/218670. Epub 2013 Aug 29.
Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20 mm) were treated by ESD. They were divided into Group A (20-49 mm, 511 cases) and Group B (≧50 mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0 mm, and 60.0 min in Group A, and they were 67.1 years, 64.2 mm, and 119.6 min in Group B. En bloc resection rates were 99.2% and 99.0% (P = 0.80), and complication rates were 4.1% and 9.9% (P = 0.03). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors.
背景与目的。由于技术难度和可能的并发症，内镜下黏膜剥离术（ESD）在大肠大病变中未得到广泛应用。我们旨在探讨ESD治疗大肠大肿瘤的有效性和安全性。患者与方法。在过去5年中，608例大肠肿瘤（≧20 mm）患者接受了ESD治疗。他们被分为A组（20 - 49 mm，511例）和B组（≧50 mm，97例）。结果。A组的平均年龄、病变大小和手术时间分别为67.4岁、30.0 mm和60.0分钟，B组分别为67.1岁、64.2 mm和119.6分钟。整块切除率分别为99.2%和99.0%（P = 0.80），并发症发生率分别为4.1%和9.9%（P = 0.03）。A组的并发症包括穿孔（2.7%）、出血（1.2%）和缺血性结肠炎（0.2%）。B组的并发症为穿孔（8.2%）和出血（1.0%）。A组有2例因穿孔需要急诊手术，B组无。结论。A组和B组在疗效上无差异。B组并发症更常见，但B组所有穿孔均成功保守处理。ESD治疗大肠大肿瘤有效且安全。
