内镜黏膜下剥离术治疗回盲瓣脂肪瘤的临床分析

A clinical research of endoscopic submucosal dissection for ileocecal valve lipoma

摘要:

目的 探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗回盲瓣脂肪瘤的疗效及安全性。方法 2013年12月至2023年6月间在复旦大学附属中山医院行ESD治疗的回盲部脂肪瘤病例纳入回顾性队列研究。根据病变位置分为回盲瓣组和盲肠组，比较两组的手术时间、手术速度、整块切除率、并发症情况及随访情况等。结果 共纳入59例回盲部脂肪瘤患者，其中回盲瓣组31例，盲肠组28例。两组间性别、年龄、标本大小、病灶大小差异无统计学意义（P>0.05）。回盲瓣组和盲肠组患者均成功行ESD切除，整块切除率分别为100.0%（31/31）和92.9%（26/28），差异无统计学意义（χ2=0.033，P=0.133）。回盲瓣组中位手术时间为26 min，盲肠组为20 min，差异有统计学意义（Z=-0.136，P=0.027）；回盲瓣组中位手术速度为0.14 cm2/min，盲肠组为0.24 cm2/min，差异有统计学意义（Z=-0.223，P=0.022）。术后回盲瓣组出现1例发热，盲肠组1例术后出血。中位随访38个月（7~106个月），无一例病灶残留或复发。结论 回盲瓣脂肪瘤ESD治疗虽具有一定手术难度，但仍是一项安全可行且有效的治疗方法。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma. Methods A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared. Results A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups (P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant (χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm²/min VS cecum group 0.24 cm²/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.