摘要
目的观察结直肠侧向发育型肿瘤(laterally spreading tumors,LST)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月至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LST并发症少、安全有效,不同的内镜治疗方法各有优势。
Objective To analyze the endoscopic and pathological features of laterally spreading tumors(LST)and to explore the risk factors for carcinogenesis and submucosal invasion.Methods From January 2019 to August 2021,the gender,age,endoscopic and pathological characteristics of patients with colorectal LST who underwent endoscopic treatment in the First Hospital of China Medical University were retrospectively analyzed.Univariate analysis was used to determine the risk factors for carcinogenesis and submucosal invasion,and the factors with significant differences were included in multivariate logistic regression analysis.Results A total of 422 patients were enrolled,including 224 males and 198 females,with the mean age of 63.45±9.23 years.A total of 456 LST lesions were detected.The length of endoscopic resection specimens was 3.01±0.48 cm and the length of lesions was 2.37±1.59 cm.One hundred and fifteen(25.2%)lesions were located in the rectum,40(8.8%)in the sigmoid colon,26(5.7%)in the descending colon,109(23.9%)in the transverse colon,112(24.6%)in the ascending colon,54(11.8%)in the caecum.Endoscopic submucosal dissection(ESD),endoscopic mucosal resection(EMR),EMR with pre-cutting,and ESD with snare were performed in 237(52.0%),95(20.8%),113(24.8%)and 11(2.4%)lesions.Hemorrhage occurred in 4 lesions and perforations occurred in 5.Pathological results showed 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 more than 2 cm,the location of the lesion in the rectum,the endoscopic classification of LST-NG pseudodepressed type(LST-NG-PD),LST-G homogenous type(LST-G-H)and LST-G nodular mixed type(LST-G-M),and the presence of large nodules were independent risk factors for carcinogenesis.Endoscopic classification of LST-NG-PD and LST-G-M and the presence of large nodules were independent risk factors for submucosal infiltration.Conclusion There are significant differences in the endoscopic and pathological features of the four subtypes of LST.The size and the location of the lesion,the endoscopic classification and the presence of large nodules are independent risk factors for carcinogenesis.Endoscopic classification and the presence of large nodules are independent risk factors for submucosal infiltration.Endoscopic treatment of LST is safe and effective with less complications.Different endoscopic treatment methods have their own advantages.
作者
赵天翔
张凤娟
孙明军
Zhao Tianxiang;Zhang Fengjuan;Sun Mingjun(Department of Endoscopy,The First Hospital of China Medical University,Shenyang 110000,China)
出处
《中华消化内镜杂志》
CSCD
2023年第8期639-647,共9页
Chinese Journal of Digestive Endoscopy
关键词
结直肠肿瘤
肿瘤浸润
侧向发育型肿瘤
内镜黏膜下剥离术
内镜黏膜切除术
Colorectal neoplasms
Tumor-infiltrating
Laterally spreading tumors
Endoscopic submucosal dissection
Endoscopic mucosal resection
