内镜黏膜下剥离术治疗累及齿状线的早期直肠或肛管病变的临床疗效和安全性初探（含视频）

Clinical efficacy and safety of endoscopic submucosal dissection for early rectal or anal canal lesions involving the dentate line (with video)

摘要:

回顾性分析2022年1月至2023年7月在江苏省中医院消化内镜中心行内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗的13例累及齿状线的直肠或肛管病变患者的病例资料，评价ESD的疗效及安全性。13例患者共计14处累及齿状线的直肠或肛管病变完成ESD治疗，病变长径1.4~12.5 cm，平均5.4 cm，均一次性切除，R0切除率92.31%（12/13），ESD治疗时间35~225 min，平均88.3 min。术后并发肛管狭窄1例，指导扩肛器扩张治疗后好转；无迟发性出血、穿孔等并发症发生。ESD术后病理提示管状绒毛状腺瘤6处，管状腺瘤2处，管状腺癌3处，鳞状上皮内瘤变2处（2处均合并人乳头瘤病毒感染）。其中一例管状腺癌病变侧切缘局部见绒毛管状腺瘤；余病变侧切缘及基底切缘均阴性。中位随访时间7.0个月（2~13个月），无局部残留及复发转移。ESD治疗累及齿状线的早期直肠或肛管病变安全有效，可能成为此类病变的首选治疗方式。

Abstract:

A retrospective analysis was conducted on data of 13 patients with rectal or anal canal lesions involving the dentate line who underwent endoscopic submucosal dissection (ESD) at the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2022 to July 2023. The efficacy and safety of ESD were evaluated. ESD was performed on 14 lesions in 13 patients. The lesions had a length of 1.4 to 12.5 cm and 5.4 cm in average, which were removed entirely in a single session, with an R0 resection rate of 92.31% (12/13). The ESD procedure duration ranged from 35 to 225 minutes, with an average of 88.3 minutes. Anal canal stenosis occurred in 1 case after ESD, which was improved after treatment with anal dilatation. No delayed bleeding, perforation, or other complications occurred. Pathological examination after ESD revealed 6 tubulovillous adenoma, 2 tubular adenoma, 3 tubular adenocarcinoma, and 2 squamous epithelial intraepithelial neoplasia (both 2 lesions were combined with human papillomavirus infection). In one case of tubular adenocarcinoma, the local resection margin showed focal tubulovillous adenoma, while the other cases were negative on lateral margins around and basal margins. The median follow-up period was 7.0 months (range 2 to 13 months), with no local residue, recurrence or metastasis observed. ESD is safe and effective for early rectal or anal canal lesions involving the dentate line, and is worthy of clinical promotion and application.