内镜黏膜下剥离术治疗老年人结直肠浅表肿物发生穿孔的危险因素分析

Risk factors for perforation of superficial colorectal tumor in elderly patients treated by endoscopic submucosal dissection

摘要:

为探讨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、危险因素，回顾2017年1月至2020年10月于首都医科大学附属北京友谊医院接受结直肠ESD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。共收集278例患者，年龄（68.62±6.82）岁，60~<75岁218例，75~<90岁60例；病变位于回盲部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。病灶长径（2.32±1.36）cm，<2 cm者117例，2~<5 cm者138例，≥5 cm者23例。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。结果显示，右半结肠病变穿孔发生率高于左半结肠，恶性病变穿孔发生率高，病灶长径越大发生穿孔的风险越高。恶性病变、病灶长径≥2 cm、病变部位是ESD穿孔的独立危险因素。

Abstract:

To explore the clinical characteristics and risk factors of perforation during endoscopic submucosal dissection (ESD) of superficial colorectal tumor in elderly patients, clinical data including patients'' medical history, characteristics of colorectal lesions, operation process and prognosis in the elderly patients who underwent colorectal ESD at Beijing Friendship Hospital, Capital Medical University from January 2017 to October 2020 were retrospectively analyzed. A total of 278 patients were collected with the age of 68.62±6.82 years. There were 218 patients aged 60-< 75 years and 60 patients aged 75-< 90 years. There were 32 lesions at the ileocecum, 51 at the ascending colon, 20 at the transverse colon, 12 at the descending colon, 54 at the sigmoid colon, and 109 at the rectum. The long diameter of the lesions was 2.32±1.36 cm with 117 cases <2 cm, 138 cases 2-<5 cm, and 23 cases ≥5 cm. There were 150 adenomas, 23 high grade intraepithelial neoplasms, 65 malignant lesions, 18 neuroendocrine tumors, 3 benign lesions, and 19 inflammatory lesions. Intraoperative perforation occurred in 25 cases and postoperative perforation occurred in 2. The results showed that the incidence of perforation in the right half of the colon was higher than that in the left half. The incidence of perforation was higher in malignant lesions and those with larger long diameter of the lesion. Malignant lesions, long diameter ≥2 cm, and the lesion site are independent risk factors for ESD perforation.