结直肠肿瘤内镜黏膜下剥离术完整切除及手术时间的影响因素分析
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Influencing factors for complete resection and operation time in endoscopic submucosal dissection for colorectal tumors
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    摘要:

    目的 探讨结直肠肿瘤内镜黏膜下剥离术(ESD)完整切除及手术时间的影响因素。方法 收集2013年1月至2014年12月在吉林大学第一医院胃肠内科内镜中心行结直肠ESD手术的88例患者的95处病变,评估所有纳入病例的临床结果,用Logistic回归分析研究影响完整切除及手术时间的因素。结果 病变大小8~80 mm,平均(28.7±14.1)mm;平均手术时间(80.72±63.90)min。95处病变中,总体完整切除率为92.6%(88/95),非完整切除率为7.4%(7/95)。多因素回归分析示纤维化(P=0.012,OR=52.473,95%CI:2.571~1 140.438)是导致非完整切除的独立危险因素,纤维化(P=0.001,OR=0.045,95%CI:0.007~0.289)、病变大小(P=0.035,OR=0.170,95%CI:0.033~0.884)、病变形态(颗粒型侧向发育型:P=0.013,OR=34.432,95%CI:2.138~554.476;非颗粒型侧向发育型:P=0.044,OR=31.715,95%CI:1.093~919.904)是延长手术时间的独立危险因素。结论 重度纤维化容易导致非完整切除。纤维化程度越重、病变越大,手术时间越长。

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    Objective To explore influencing factors for complete resection and operation time of endoscopic submucosal dissection(ESD) for colorectal tumors. Methods This retrospective study included 95 consecutive colorectal tumors in 88 patients whose pathological diagnosis was adenoma and carcinoma, treated with ESD at the Department of Endoscopy of the First Hospital of Jilin University from January 2013 to December 2014. Multiple logistic regression analysis was conducted on the factors related to complete resection and operation time. Results Average tumor size was 28.7±14.1 mm(range,8-80 mm), and the average procedure time was 80.72±63.90 min. The rate of complete resection was 92.6%(88/95),and the rate of incomplete resection was 7.4%(7/95). Multivariate logistic regression analysis revealed that fibrosis (P=0.012,OR=52.473, 95%CI:2.571-1 140.438) contributed to incomplete resection. Fibrosis (P=0.001,OR=0.045, 95%CI:0.007-0.289),tumor size (P=0.035,OR=0.170, 95%CI:0.033-0.884),granular-type laterally spreading tumor(P=0.013,OR=34.432, 95%CI:2.138-554.476), non-granular-type laterally spreading tumor(P=0.044,OR=31.715, 95%CI:1.093-919.904) were independent factors for extending operation time of colorectal ESD. Conclusion The severer fibrosis can induce higher rate of incomplete resection. The more severe fibrosis is, the larger tumor size is, and the longer operation time is.

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韩梅,李蓥,詹婧,等.结直肠肿瘤内镜黏膜下剥离术完整切除及手术时间的影响因素分析[J].中华消化内镜杂志,2017,34(2):122-126.

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  • 在线发布日期: 2017-04-26
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