de novo早期结直肠癌的临床病理特征及内镜治疗效果观察
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1.首都医科大学附属北京友谊医院消化分中心;2.首都医科大学附属北京友谊医院消化内科

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北京市科技计划项目(Z191100006619082,Z191100006619083)


Clinicopathological characteristics and endoscopic treatment efficacy of de novo early colorectal cancer
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Beijing Science and Technology Project (Z191100006619082, Z191100006619083)

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    摘要:

    目的 分析de novo早期结直肠癌的临床病理特征,并评估内镜治疗的效果。方法 纳入2020年6月—2022年5月在首都医科大学附属北京友谊医院行内镜切除且术后病理确诊为de novo早期结直肠癌的患者。回顾性收集患者的基本资料、内镜表现、治疗方式、术后病理结果以及转归等资料。结果 共纳入33例de novo早期结直肠癌患者,年龄(62.67±8.62)岁,男女比例7.25∶1。病变长径(0.96±0.36)cm;病变形态以浅表型(0‑Ⅱ型)为主,占72.7%(24/33)。29例采用内镜黏膜下剥离术切除,4例采用内镜黏膜切除术切除。术后病理显示,11例(33.3%)为高分化管状腺癌,其中2例侵及黏膜下浅层;20例(60.6%)为中分化管状腺癌,其中5例侵及黏膜下浅层,15例侵及黏膜下深层;2例(6.1%)为中-低分化管状腺癌,均侵及黏膜下深层。病变浸润深度与病变分化程度有显著相关性(P<0.001),中分化及中-低分化病变更容易发生黏膜下层深浸润。33例(100.0%)病变均达到整块切除,97.0%(32/33)达到完全切除,42.4%(14/33)达到治愈性切除。19例未达到治愈性切除标准的患者中,13例患者接受了补充外科手术治疗,术后病理均未见肿瘤残余及淋巴结转移。所有患者随访3~25个月,均未见肿瘤局部复发及转移征象。结论 de novo早期结直肠癌内镜下大多呈浅表型病变,病理类型以中分化管状腺癌为主。内镜下切除de novo早期结直肠癌可取得较好的短期疗效。

    Abstract:

    Objective To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment. Methods Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively. Results A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0‑Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately‑poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation (P<0.001), and moderately and moderately‑poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3‑25 months, and no signs of local recurrence or metastasis were found. Conclusion Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short‑term efficacy.

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刘春涛,苏珈仪,孙秀静,等. de novo早期结直肠癌的临床病理特征及内镜治疗效果观察[J].中华消化内镜杂志,2023,40(7):521-526.

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  • 收稿日期:2022-08-13
  • 最后修改日期:2023-06-30
  • 录用日期:2022-12-04
  • 在线发布日期: 2023-07-04
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