内镜黏膜下剥离术治疗结直肠肿瘤不完整切除和手术时间延长的风险因素

doi:10.3969/j.issn.1006-7795.2022.06.022

摘要/Abstract

摘要： 目的分析应用结肠内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗结直肠肿瘤患者期间发生不完整切除和手术时间延长的危险因素。方法收集自2014年2月至2021年11月间就诊于首都医科大学附属北京友谊医院因结直肠肿瘤行ESD治疗的患者资料,采取χ²检验和Logistic回归模型分析导致ESD不完整切除和手术时间延长的危险因素。结果本研究共纳入433例患者进行分析。顺利完成ESD治疗的患者占98.8%(428/433),平均手术时长为(67.91±64.28)min。不完整切除率为20.56%(88/428),其危险因素包括肿瘤直径超过4 cm(P=0.001,OR=3.017,95%CI: 1.536~5.924),伴有严重纤维化(P<0.001,OR=5.825,95%CI: 2.540~13.355)和注射后抬举不良(P=0.025,OR=2.831,95%CI:1.141~7.025)。手术时间延长的患者占15.7%(67/428),其危险因素为女性(P=0.044,OR=1.832,95%CI: 1.017~3.300),肿瘤直径超过4 cm(P<0.001,OR=10.276,95% CI: 5.340~19.774)。结论大直径肿瘤、合并溃疡性结肠炎、肿瘤伴严重纤维化以及抬举征阳性为不完整切除的危险因素;女性患者以及大直径肿瘤会导致手术时间延长。

关键词: 结肠内镜, 内镜黏膜下剥离术, 完整切除, 手术时间延长, 危险因素

Abstract: Objective To investigate risk factors for incomplete resection and prolonged operative duration of endoscopic submucosal dissection (ESD) for colorectal tumors. Methods Patients who received ESD procedures for colorectal tumors at Beijing Friendship Hospital, Capital Medical University between February 2014 and November 2021 were included in the study. The Chi-square test and logistic regression model were applied to analyze risk factors for incomplete resection and prolonged operative duration of ESD. Results A total of 433 patients were included in the final analysis. 98.8% of ESD procedures were completed successfully (428/433) and the mean operative time was (67.91±64.28) minutes. Incomplete resection rate was 20.56% (88/428), and risk factors for incomplete resection were tumor size over 4 cm (P=0.001,OR=3.017, 95%CI: 1.536-5.924), severe submucosal fibrosis(P<0.001, OR=5.825, 95%CI: 2.540-13.355)and the non-lifting sign(P=0.025,OR=2.831,95%CI:1.141-7.025). 15.7% of patients (67/428) underwent prolonged ESD which last more than 120 minutes. Female (P=0.044,OR=1.832,95%CI: 1.017-3.300), tumor size over 4cm (P<0.001,OR=10.276,95%CI: 5.340-19.774)were significantly associated with prolonged operative duration. Conclusion Risk factors for incomplete resection included tumor size larger than 4cm, tumor with ulcerative colitis, severe submucosal fibrosis, and the non-lifting sign. Risk factors for prolonged operative time included female patients and larger tumor size.

Key words: colonoscopy, endoscopic submucosal dissection, complete resection, prolonged operation duration, risk factors

中图分类号:

谷丰, 姜维, 刘宇航, 翟惠虹. 内镜黏膜下剥离术治疗结直肠肿瘤不完整切除和手术时间延长的风险因素[J]. 首都医科大学学报, 2022, 43(6): 959-965.

Gu Feng, Jiang Wei, Liu Yuhang, Zhai Huihong. Risk factors for incomplete resection and prolonged operative duration of endoscopic submucosal dissection for colorectal tumors[J]. Journal of Capital Medical University, 2022, 43(6): 959-965.

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