摘要
背景预切开内镜下黏膜切除术(endoscopic mucosal resection with precutting,Pre-cut-EMR)是一种在EMR基础上进行改良,融合了EMR和内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)的技术优势,形成的一种新的内镜下切除方法,在临床上应用越来越广泛.本研究通过回顾性分析,初步探讨Precut-EMR对结直肠侧向发育型肿瘤(laterally spreading tumor,LST)治疗的临床价值.目的初步探讨Pre-cut-EMR在LST治疗中的应用价值.方法选择2016-01/2019-12我科就诊的84例结直肠LST患者为研究对象,回顾性分析所有患者临床资料,总结结直肠LST的临床特征.所有患者均行Pre-cut-EMR,计算平均手术时间、整块切除率、完整切除率、并发症发生率;术后第3、6、12 mo复查肠镜,评估复发情况.通过中国知网和万方数据库检索ESD治疗结直肠LST相关文献,比较Pre-cut-EMR组与ESD组对结直肠LST治疗疗效有无统计学差异.结果本研究中84例结直肠LST平均直径25.6 mm;内镜下形态分型以颗粒型为主.按工藤pit分型,以Ⅲ型和Ⅳ型多见,其中ⅢL最常见.病理类型以管状腺瘤和绒毛状腺瘤多见.84例结直肠LST患者均成功内镜下切除,其中1例中转ESD手术、1例中转EPMR,Pre-cut-EMR整块切除率为97.6%,共有3例基底切缘阳性,完整切除率为96.4%,平均手术时间24.5 min.术中共出现2例出血、1例穿孔,并发症发生率3.6%.已完成随访的78例患者均未见复发,复发率0%.经统计学分析,与徐美东等、于红刚等、加拿提·秋海等研究数据相比较,Pre-cut-EMR组在手术时间方面明显低于ESD组,差异有统计学意义(χ^2=21.037,P=0.001);而在整块切除率、完整切除率、并发症发生率和复发率方面与ESD组相比均无统计学差异(P>0.05).结论Pre-cut-EMR对结直肠LST治疗的疗效确切、安全性高,有较高临床价值.该手术方法因操作简单、易于掌握、设备要求低等特点值得大范围推广.
BACKGROUND Endoscopic mucosal resection(EMR)with precutting(Pre-cut-EMR)is an improvement on the basis of EMR,which combines the technical advantages of EMR and endoscopic submucosal dissection(ESD)to form a new endoscopic resection method and is more and more widely used in clinical practice.This study preliminarily explored the clinical value of Pre-cut-EMR in the treatment of colorectal laterally spreading tumors(LSTs)through retrospective analysis.AIM To explore the application value of Pre-cut-EMR in the treatment of colorectal LSTs.METHODS A total of 84 patients with colorectal LSTs who were treated at our department from January 2016 to December 2019 were selected as the research subjects.The clinical data of all patients were retrospectively analyzed to summarize the clinical characteristics of colorectal LSTs.All patients underwent Pre-cut-EMR,and the average operation time,overall resection rate,complete resection rate,and the incidence of complications were recorded.Colonoscopy was performed at 3,6,and 12 mo after the operation to evaluate the recurrence.The relevant literature on ESD treatment of colorectal LSTs was retrieved through China HowNet and Wanfang Database,and the pre-cut-EMR group and ESD group were compared for the curative effect on colorectal LSTs.RESULTS The average diameter of colorectal LSTs in the 84 cases was 25.6 mm.The endoscopic morphological classification was mainly granular.According to Kudo pit classification,typesⅢandⅣwere common,with typeⅢL being the most common.Tubular adenoma and villous adenoma were common pathological types.All 84 patients with colorectal LSTs underwent endoscopic resection successfully.One of them converted to ESD and one to EPMR.The pre-cut-EMR resection rate was 97.6%,and the average operation time was 24.5 min.There were three cases with positive basal margins,and the complete resection rate was 96.4%.Two cases of bleeding and one case of perforation occurred during the operation,and the complication rate was 3.6%.None of the 78 patients who were followed had recurrence,and the recurrence rate was 0%.Compared with the research data obtained by Xu et al,Yu et al,and Qiuhai et al,the operation time of the Pre-cut-EMR group was significantly lower than that of the ESD group(χ^2=21.037,P=0.001),but there was no statistical difference in the overall resection rate,complication rate,complete resection rate,or recurrence rate compared with the ESD group(P>0.05).CONCLUSION Pre-cut-EMR is effective and safe for colorectal LST treatment,and has high clinical value.This surgical method deserves to be widely promoted due to its simplicity,being easy to learn,and low equipment requirements.
作者
谈涛
李蜀豫
Tao Tan;Shu-Yu Li(Department of Gastroenterology,The Third People’s Hospital of Hubei Province,Jianghan University,Wuhan 430033,Hubei Province,China)
出处
《世界华人消化杂志》
CAS
2020年第24期1272-1278,共7页
World Chinese Journal of Digestology
关键词
预切开内镜下黏膜切除术
侧向发育型肿瘤
疗效
临床推广
Pre-cutting endoscopic mucosal resection
Laterally spreading tumor
Curative effect
Clinical promotion
