结直肠内镜黏膜下剥离术的临床结局及与分片切除相关的危险因素
Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection.
作者信息
Seo Myeongsook, Yang Dong-Hoon, Kim Jihun, Song Eun Mi, Kim Gwang Un, Hwang Sung Wook, Park Sang Hyoung, Kim Kyung-Jo, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun
机构信息
Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea.
Department of Pathology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea.
出版信息
Turk J Gastroenterol. 2018 Jul;29(4):473-480. doi: 10.5152/tjg.2018.17400.
BACKGROUND/AIMS: We aimed to investigate the factors associated with piecemeal resection of colorectal neoplasia (CRN), in spite of endoscopic submucosal dissection (ESD).
MATERIALS AND METHODS
We analyzed the retrospective data for colorectal ESD cases from January 2005 to April 2014. We also reviewed the piecemeal endoscopic mucosal resection (EMR) for CRNs ≥20 mm, performed over the same period.
RESULTS
En bloc resection was possible in 648 (85.7%) of 756 lesions in 740 patients. Multivariate analysis showed that hybrid ESD (odds ratio (OR), 29.07; 95% confidence interval (CI), 15.46-54.65; p<0.01) and mild or severe submucosal fibrosis (OR, 3.62; 95% CI, 1.94-6.76; p<0.01) were independently associated with piecemeal ESD. The en bloc ESD group showed higher histologic complete resection rate than the piecemeal ESD group (80.4% vs. 56.5%; p<0.01), and the piecemeal ESD group showed higher recurrence rate than in the en bloc ESD group (5.6% [4/72] vs. 0.7% [3/450]; p<0.01). Overall recurrence rate was 1.3% (7/522).
CONCLUSION
Hybrid ESD and submucosal fibrosis are independently associated with piecemeal ESD. Piecemeal ESD cases recurred more frequently than en bloc ESD cases.
背景/目的：尽管采用了内镜黏膜下剥离术（ESD），我们旨在研究与大肠肿瘤（CRN）分片切除相关的因素。
材料与方法
我们分析了2005年1月至2014年4月大肠ESD病例的回顾性数据。我们还回顾了同期对直径≥20 mm的CRN进行的分片内镜黏膜切除术（EMR）。
结果
740例患者的756个病变中，648个（85.7%）实现了整块切除。多因素分析显示，混合ESD（优势比（OR），29.07；95%置信区间（CI），15.46 - 54.65；p<0.01）以及轻度或重度黏膜下纤维化（OR，3.62；95% CI，1.94 - 6.76；p<0.01）与ESD分片切除独立相关。整块ESD组的组织学完全切除率高于ESD分片切除组（80.4%对56.5%；p<0.01），ESD分片切除组的复发率高于整块ESD组（5.6%[4/72]对0.7%[3/450]；p<0.01）。总体复发率为1.3%（7/522）。
结论
混合ESD和黏膜下纤维化与ESD分片切除独立相关。ESD分片切除病例的复发频率高于整块ESD病例。
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