ESD治疗老年人结直肠病变的疗效与安全性分析

发布时间：2018-04-26 21:29

本文选题：ESD + 结直肠病变　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨ESD治疗老年人结直肠病变的疗效与安全性,分析其影响因素。方法:回顾性分析2011年5月至2016年12月在浙江大学附属第一医院行ESD治疗的240例(249个病灶)结直肠黏膜及黏膜下病变患者的临床及病理资料,比较老年人ESD的成功率、治疗效果及并发症发生情况与非老年人之间的差异。结果:早期结直肠癌患者中有症状者占69.2%,老年人占76.5%。黏膜下病灶主要位于直肠(86.96%);黏膜病变主要位于直肠(45.56%)、乙状结肠(21.11%)、升结肠(19.44%)。老年人病理类型以低级别上皮内瘤变与高级别上皮内瘤变为主,非老年人则以低级别上皮内瘤变与类癌为主。可评估大小的237例病灶中,黏膜下隆起69例,平均直径0.87±0.49cm;黏膜病变180例,平均直径为2.89±1.52cm。不同病理类型病变的大小在老年人与非老年人之间无显著性差异。老年人结直肠ESD术的成功率(97.0%)稍高于非老年人(96.6%),整块切除率(87.2%)低于非老年人(91.5%),完全切除率(72.9%)低于非老年人(80.2%),治愈性切除率(67.7%)低于非老年人(72.4%),并发症发生率(6.0%)与非老年人(6.0%)相近。老年人ESD术后平均住院时间(5.63±2.76天)高于非老年人(5.10±1.92天)(P=0.043)。病灶长径(P=0.032)、年龄(P=0.036)为发生并发症的相关因素,而病灶位置、病理类型与发生并发症无相关性(p0.05)。病灶长径和年龄同样也是分块切除的相关因素(P长径=0.036,P年龄=0.048)。黏膜病变术后病理标本侧缘和(或)基底阳性的发生率为14.1%(22/156),黏膜下病变为17.9%(12/67)。切缘阳性的黏膜下病灶平均直径为0.90±0.33cm,与切缘阴性的黏膜下病灶0.79±0.35cm无显著性差异(P=0.303)。切缘阳性的黏膜病变的平均直径为2.80±1.06cm,显著大于切缘阴性的黏膜病灶2.66±1.33cm(P=0.000)。ESD术后总复发率为0.0%～0.1%。结论:ESD治疗老年人结直肠病变具有良好的疗效与安全性。病灶越大,患者年龄越大,发生并发症、分块切除的可能性越大。与黏膜病变相比,黏膜下病变切缘阳性的可能性更大。对于黏膜病变,病灶越大、浸润深度越深,切缘阳性的可能性越大。
[Abstract]:Objective: to investigate the efficacy and safety of ESD in the treatment of colorectal lesions in the elderly and analyze its influencing factors. Methods: the clinical and pathological data of 240 patients (249 lesions) with colorectal mucosal and submucosal lesions treated with ESD in the first affiliated Hospital of Zhejiang University from May 2011 to December 2016 were analyzed retrospectively. The success rate of ESD in the elderly was compared. The difference between the effect of treatment and the occurrence of complications was compared with that of non-elderly people. Results: 69.2% of the patients with early colorectal cancer and 76.55% of the elderly had symptoms. The submucosal lesions were mainly located in the rectum (86.96), the mucosal lesions in the rectum (45.56), the sigmoid colon (21.11) and the ascending colon (19.44). The pathological types of the elderly were mainly low grade intraepithelial neoplasia and high grade intraepithelial neoplasia, while non-elderly patients were mainly low grade intraepithelial neoplasia and carcinoid. Of the 237 lesions, 69 were submucosal eminence with an average diameter of 0.87 卤0.49 cm, and 180 had mucosal lesions with an average diameter of 2.89 卤1.52 cm. There was no significant difference in the size of different pathological types between the elderly and the non-elderly. The successful rate of colorectal ESD in the elderly was slightly higher than that in the non-elderly patients (96.6%) and the whole resection rate was 87.2%) lower than that in the non-elderly group (91.5%, complete resection rate 72.9%) lower than that in the non-elderly group (80.22%), and the cure rate was 67.7%) lower than that in the non-elderly group (72.4%, the complication rate was 6.0), and the incidence of complications was similar to that in the non-elderly group (6.0). The average hospitalization time after ESD in the elderly was 5.63 卤2.76 days, which was higher than that in the non-elderly patients (5.10 卤1.92 days). P0. 032, age (P0. 036) were the related factors of complications, but there was no correlation between the location and pathological type of lesions and the occurrence of complications (p0. 05). The length and age of lesion were also related factors of segmental resection. The incidences of positive lateral margin and / or basal base in pathological specimens after mucosal lesions were 14.1or 22 / 156g, and 17.9 / 67 / 67 for submucosal lesions. The mean diameter of submucosal lesions with positive margin was 0.90 卤0.33 cm, and there was no significant difference between 0.79 卤0.35cm of submucosal lesions with negative margin. The average diameter of mucosal lesions with positive margin was 2.80 卤1.06cm, which was significantly larger than that of negative lesions (2.66 卤1.33cm(P=0.000).ESD). Conclusion: ESD is effective and safe in the treatment of colorectal diseases in the elderly. The older the lesion, the older the patient, the more likely the complication and the greater the possibility of segmental resection. Compared with mucosal lesions, submucosal lesions were more likely to be positive. For mucosal lesions, the larger the lesion, the deeper the depth of invasion and the greater the possibility of positive margin.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574

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