结直肠侧向发育型肿瘤的内镜特征及癌变、黏膜下浸润的危险因素分析

Endoscopic characteristics of laterally spreading tumors and risk factors for cancerization and submucosal invasion

摘要:

目的 观察结直肠侧向发育型肿瘤(laterally spreading tumors, LSTs)的内镜及病理学特征，探索其癌变、黏膜下浸润的危险因素。方法 回顾性分析2019年1月-2021年8月在中国医科大学附属第一医院因结直肠LST行内镜治疗患者的性别、年龄及病变的内镜和病理学特征。用单因素分析寻找癌变、黏膜下浸润的危险因素，对其中差异有统计学意义的因素再纳入多因素Logistic回归分析。结果 纳入422例患者，男224例、女198例，年龄(63.45±9.23)岁。共456处LST病灶，内镜切除标本长径（3.01±0.48）cm，病灶长径（2.37±1.59）cm，位于直肠115处（25.2%）、乙状结肠40处（8.8%）、降结肠26处（5.7%）、横结肠109处（23.9%）、升结肠112处（24.6%）、回盲部54处（11.8%）。予内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）237处（52.0%），内镜黏膜切除术（endoscopic mucosal resection，EMR）95处（20.8%），预切开EMR（EMR with pre-cutting, EMR-P）113处（24.8%），圈套器辅助ESD（ESD with snare，ESD-S）11处（2.4%），共4处迟发性出血，5处术中穿孔。病理结果，低级别上皮内瘤变119处（26.1%），高级别上皮内瘤变221处（48.5%），黏膜内癌82处（18.0%），黏膜下浸润癌34处（7.5%）。多因素Logistic回归分析显示，病灶大小(>2 cm)、病灶位置(直肠)、内镜分型[假凹陷型(LST-NG pseudodepressed type，LST-NG-PD)、颗粒均一型（LST-G homogenous type，LST-G-H）、结节混合型（LST-G nodular mixed type，LST-G-M）]、伴大结节(有)，这4项为癌变的独立危险因素；内镜分型(LST-NG-PD)、伴大结节(有)，这2项为黏膜下浸润的独立危险因素。结论 LST的4种亚型，其内镜和病理特征存在明显差异，病灶大小、病灶位置、内镜分型、伴大结节，均为癌变的独立危险因素；内镜分型、伴大结节，为黏膜下浸润的独立危险因素。内镜治疗LSTs并发症少、安全有效，不同的内镜治疗方法各有优势。

Abstract:

Objective To analyze the endoscopic and pathological features of laterally spreading tumors and to explore the risk factors of carcinogenesis and submucosal invasion. Methods From January 2019 to August 2021, the gender, age, endoscopic and pathological characteristics of patients with colorectal laterally spreading tumors who underwent endoscopic treatment in the First Affiliated Hospital of China Medical University were retrospectively analyzed. Univariate analysis was used to find the risk factors of carcinogenesis and submucosal invasion, and the factors with statistically significant differences were included in multivariate Logistic regression analysis. Results A total of 422 patients were enrolled, including 224 males and 198 females, with an average age of (63.45 ± 9.23) years. A total of 456 LST lesions were detected. There were 119 cases (26.1%) of low-grade intraepithelial neoplasia, 221 cases (48.5%) of high-grade intraepithelial neoplasia, 82 cases (18.0%) of intramucosal carcinoma, and 34 cases (7.5%) of submucosal invasive carcinoma. Multivariate Logistic regression analysis showed that the size of the lesion was more than 2 cm, the location of the lesion was rectum, the endoscopic classification was LST-NG-PD, LST-G-H and LST-G-M, and the presence of large nodules was an independent risk factor for carcinogenesis. Endoscopic classification of LST-NG-PD and LST-G-M with large nodules was an independent risk factor for submucosal infiltration. Conclusions There are significant differences in the endoscopic and pathological features of the four subtypes of LST. Endoscopic treatment of LST is less complications, safe and effective, and different endoscopic treatment methods have their own advantages.