内镜下黏膜剥离术治疗老年人结直肠浅表肿物穿孔的危险因素分析

Analysis of risk factors for perforation of superficial colorectal tumor in elderly patients treated by endoscopic mucosal dissection

摘要:

目的：总结老年人结直肠内镜黏膜下剥离术（endoscopic submucosal dissection ，ESD）穿孔的临床特点，分析导致穿孔的危险因素。 方法：回顾性总结2017年1月至2020年10月首都医科大学附属北京友谊医院所有接受结直肠ESD治疗的老年患者，分析患者病史资料，结直肠病变特点，操作过程及患者预后。 结果：共收集278例研究对象，60～74岁218例（78.4），75～89岁60例（21.6），≧90岁0例，平均年龄（68.62±6.822）岁。回盲部病变32例，升结肠51例，横结肠20例，降结肠12例，乙状结肠54例，直肠109例。病灶直径＜2cm的117例，2～5cm的138例，≧5cm的23例，病灶平均直径（2.323±1.356）cm。腺瘤150例，高级别上皮内瘤变23例，恶性病变65例，神经内分泌瘤18例，良性病变3例，炎症19例。术中穿孔25例，术后穿孔2例。 结论： 结肠病变穿孔发生率高于直肠病变，近端结肠穿孔发生率高于远端结肠，恶性病变穿孔发生率高，病灶直径越大发生穿孔的风险越高；恶性病变、病灶直径≧2cm均是ESD穿孔的独立危险因素。

Abstract:

Objective: to summarize the clinical characteristics of endoscopic submucosal dissection (ESD) in elderly patients and analyze the risk factors of perforation. Methods: All elderly patients who received colorectal ESD treatment in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2017 to October 2020 were retrospectively summarized. The patient's medical history, characteristics of colorectal lesions, operation process and prognosis were analyzed. Results: A total of 278 subjects were collected, including 218 cases (78.4) aged 60-74 years, 60 cases (21.6) aged 75-89 years, and 0 cases ≥ 90 years old, with an average age of (68.62 ± 6.822) years. There were 32 cases of ileocecal lesions, 51 cases of ascending colon, 20 cases of transverse colon, 12 cases of descending colon, 54 cases of sigmoid colon and 109 cases of rectum. The average diameter of the lesions was (2.323 ± 1.356) cm. There were 150 cases of adenoma, 23 cases of high-grade intraepithelial neoplasia, 65 cases of malignant lesions, 18 cases of neuroendocrine tumors, 3 cases of benign lesions, and 19 cases of inflammation. There were 25 cases of intraoperative perforation and 2 cases of postoperative perforation. Conclusion: The incidence of perforation in colonic lesions was higher than that in rectal lesions. The incidence of perforation in proximal colon was higher than that in distal colon. The incidence of perforation in malignant lesions was higher. The larger the diameter of the lesion, the higher the risk of perforation; Malignant lesions, lesion diameter ≥ 2cm were independent risk factors for ESD perforation.