结直肠杂交内镜黏膜下剥离术的适应证和疗效：一项大型多中心 10 年研究。
Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study.
机构信息
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
出版信息
Surg Endosc. 2022 Mar;36(3):1894-1902. doi: 10.1007/s00464-021-08471-5. Epub 2021 Apr 13.
BACKGROUND AND AIMS
Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion.
METHODS
From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, ≥ 20- < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience.
RESULTS
No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively).
CONCLUSION
Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from ≥ 20 to < 30 mm.
背景与目的
混合内镜黏膜下剥离术（ESD）是一种结直肠病变切除术，包括计划性和挽救性手术。以前的结直肠混合 ESD 研究涉及单一机构或少数操作者在短时间内进行，并且适应证的大小尚未确定。在这项多中心研究中，我们调查了符合 30mm 病变大小标准的结直肠肿瘤进行混合 ESD 的临床结果。
方法
从 2008 年 1 月至 2018 年 12 月，广岛 GI 内镜研究组对 172 个病变（直径范围≥20-<30mm）进行了结直肠混合 ESD。我们比较了计划性和挽救性组中 56 例和 116 例病变的临床病理特征和结果。我们还比较了 2008 年至 2013 年（第一期）和 2014 年至 2018 年（第二期）的数据，以评估操作者的经验。
结果
计划性和挽救性组的完全整块切除率无显著差异（分别为 92.9%和 83.6%）。计划性组的手术时间（44.5 分钟）短于挽救性组（72.0 分钟，p<0.01）。挽救性组穿孔率（21.6%）高于计划性组（0%，p<0.01）；然而，挽救性组圈套器穿孔率为 1.8%。与第一期相比，第二期的完全整块切除率（分别为 95.7%和 75.6%，p<0.01）和经验丰富操作者率（分别为 75.5%和 53.9%，p<0.01）均显著升高。此外，第二期计划性和挽救性组的完全整块切除率无显著差异（分别为 100%和 94.4%）。
结论
对于直径为 20-<30mm 的病变，结直肠混合 ESD，尤其是经验丰富的操作者进行的挽救性混合 ESD，是可行和安全的。
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