结直肠侧向发育型肿瘤内镜黏膜下剥离术手术时长的影响因素

Risk factors for prolonged procedure time of endoscopic submucosal dissection for colorectal laterally spreading tumors

摘要:

目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗结直肠侧向发育型肿瘤（laterally spreading tumor，LST）手术时长的影响因素。方法回顾性纳入于2013年6月—2019年3月在北京市消化疾病中心行ESD治疗的结直肠LST患者。对ESD手术时间延长（≥60 min）的影响因素先进行单因素分析，对于其中有统计学差异的因素再纳入多因素Logistic回归分析独立危险因素。结果纳入了201位患者，年龄(65.05±10.44)岁，其中男性占53.73%。患者有病变213处，病变长径(2.52±1.67)cm。病变整块切除率、完整切除率和治愈性切除率分别为93.90%、84.04%和79.81%。术中穿孔率、迟发穿孔率和迟发出血率分别为1.88%、0.94%和1.41%。单因素分析显示，病变直径≥3 cm（OR=13.48，P<0.001）、结节混合型（OR=25.28，P=0.002）、颗粒均一型（OR=9.00，P=0.045）、位于直乙部位（OR=3.08，P=0.002）以及抬举征阴性（OR=3.40，P=0.012）与ESD手术时间延长相关。多因素Logistic回归分析表明，直径≥3 cm（OR=9.29，P<0.001）、结节混合型（OR=8.80，P=0.043）和抬举征阴性（OR=3.43，P=0.043）是手术时间延长的独立危险因素。ESD手术时间延长，病变的完整切除率（69.56%比88.55%，P=0.003）和治愈性切除率（63.64%比85.50%，P=0.002）显著降低，发生癌变的风险显著升高（86.96%比51.91%，P<0.001）。结论当LST直径≥3 cm、结节混合型或抬举征阴性时，ESD的手术时间延长。手术时间越长，ESD的切除效率越低，病变发生癌变的风险越高。

Abstract:

ObjectiveTo investigate the risk factors for prolonged procedure time of endoscopic submucosal dissection (ESD) for colorectal laterally spreading tumors (LSTs). MethodsConsecutive patients who underwent ESD for colorectal LSTs at Beijing Digestive Disease Center from June 2013 to March 2019 were retrospectively analyzed. Univariate analysis was used to identify factors associated with prolonged procedure time (≥60 min). Factors with significant difference in univariate analysis were included in multivariate logistic regression to determine the independent risk factors. ResultsA total of 201 patients (age 65.05±10.44 years old, 53.73% were males) with 213 LSTs (diameter 2.52±1.67 cm) were included. En bloc resection rate, complete resection rate and curative resection rate were 93.90%, 84.04% and 79.81%, respectively. Intraoperative perforation rate, delayed perforation rate and delayed bleeding rate were 1.88%, 0.94% and 1.41%, respectively. Diameter ≥3 cm (OR=13.48，P<0.001), granular nodular mixed (G-NM) subtype (OR=25.28，P=0.002), granular homogenous subtype (OR=9.00，P=0.045), location of rectosigmoid (OR=3.08，P=0.002) and positive non-lifting sign (OR=3.40，P=0.012) were associated with longer procedure time in univariate analysis. In multivariate logistic regression, diameter ≥3 cm (OR=9.29，P<0.001), G-NM subtype (OR=8.80，P=0.043) and positive non-lifting sign (OR=3.43，P=0.043) were independent risk factors for prolonged procedure time. Longer procedure time was associated with lower rates of complete resection (69.56% VS 88.55%，P=0.003) and curative resection (63.64% VS 85.50%，P=0.002), and increased rate of carcinoma (86.96% VS 51.91%，P<0.001). Conclusion LSTs of size over 3 cm, G-NM subtype or positive non-lifting sign predict prolonged procedure time, which is associated with reduced efficacy of ESD and higher risk of carcinoma.