内镜黏膜下剥离术治疗盲肠侧向发育型肿瘤的疗效分析

Efficacy observation of endoscopic submucosal dissection for cecum laterally spreading tumors

关键词:  内镜黏膜下剥离术  盲肠侧向发育型肿瘤  JNET分型

Key words:  endoscopic submucosal dissection  cecum laterally spreading tumors  JNET classification

摘要:

目的 探讨内镜黏膜下剥离术（ESD）对于盲肠侧向发育型肿瘤（laterally spreading tumors，LSTs）的临床疗效。方法 回顾性分析大连医科大学附属第一医院2016年12月至2019年12月收治的应用ESD治疗的41例盲肠侧向发育型肿瘤患者的病例资料，观察并统计LSTs的表面形态分型（JNET分型）、病变大小，分析手术完整切除率、完全切除率（R0）、病理结果及手术并发症等情况，并且随访手术后的并发症和复发情况。结果 病变平均直径为（1.91±0.83）cm；完整切除率为100%，R0为95.1%（39/41）。术后病理结果Type 1型中，77.8%（7/9）病灶被诊断为锯齿状腺瘤，22.2%（2/9）病灶被诊断为增生性息肉。Type 2A型中，71.4%（20/28）病灶被诊断为低级别上皮内瘤变，28.6%（8/28）病灶被诊断为高级别上皮内瘤变。Type 2B型中，100%（4/4）病理为高级别上皮内瘤变。ESD并发术中穿孔和出血率分别为7.3%（3/41）、4.8%（2/41），未见迟发性出血和穿孔。平均随访13.6个月无复发。结论 ESD治疗盲肠侧向发育型肿瘤的完整切除率高，并发症发生率低，是治疗盲肠侧向发育型肿瘤安全可行的治疗方法。

Abstract:

Objective To evaluate the clinical effect of endoscopic submucosal dissection (ESD) for cecum laterally spreading tumors (LSTs). Methods A retrospective analysis were performed on 41 patients with cecum laterally spreading tumors, who were admitted in the First Affiliated Hospital of Dalian Medical University from December 2016 to November 2019. Superficial morphology of the tumors (JNET classification) and subtypes of LSTs were evaluated by endoscopy. Tumor size, complete resection rate, curative resection rate (R0), pathological characteristics of ESD were reviewed. Furthermore, postoperative complications and recurrence were followed up and statistically analyzed. Results The average size of the lesions was (1.91±0.83) cm. The complete resection rate was 100% and R0 95.1% (39/41). In Type 1 postoperative pathological results, 77.8% (7/9) of the lesions were diagnosed as serrated adenomas, and 22.2% (2/9) as hyperplastic polyps. In Type 2A, 71.4% (20/28) of the lesions were diagnosed as low-grade intraepithelial neoplasia, and 28.6% (8/28) as high-grade intraepithelial neoplasia. In Type 2B, 100% (4/4) of pathology was high-grade intraepithelial neoplasia. The perforation rate,bleeding rate and delayed bleeding rate were 7.3% (3/41), 4.8% (2/41) and 0, respectively. There was no recurrence after postoperative follow-up of 13.6 months.Conclusion ESD is a safe and effective method for the treatment of the cecum laterally spreading tumors.