内镜下黏膜剥离及切除术治疗早期直肠癌的预后比较
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摘要
目的研究内镜黏膜剥离术(ESD)和内镜黏膜切除术(EMR)治疗老年早期直肠癌对患者预后的影响。方法回顾性分析90例老年早期直肠癌患者临床资料,根据手术方法不同分为观察组(ESD,45例)和对照组(EMR,45例),比较两组患者基本资料、病理特点及手术相关指标,记录两组患者预后,分析观察组患者并发症发生率的分布特点。结果两组患者肿瘤位置、肿瘤分期、病理分型、分化程度及肿瘤直径比较,差异均无统计学意义(P> 0. 05)。观察组手术时间较对照组显著延长,术中出血量显著多于对照组,并发症总发生率显著高于对照组,差异均有统计学意义(P <0. 05)。观察组术后3年肿瘤无进展生存率显著高于对照组,差异有统计学意义(P <0. 05),两组术后3年生存率差异无统计学意义(P> 0. 05)。观察组中并发症患者肿瘤直径显著高于无并发症,差异有统计学意义(P <0. 05)。经ROC分析显示肿瘤直径判断观察组患者并发症的AUC为0. 718(β=0. 087,95%CL=0. 549-0. 888,P=0. 026),最佳截断值为2. 82cm。结论 ESD治疗老年早期直肠癌较EMR有助于延长患者无进展生存时间,但ESD并发症高,尤其是对于肿瘤直径超过2. 82cm的患者,应注意手术操作。
Objective To study the effect of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) to the elderly patients of early rectal cancer. Methods The clinical dataes of 90 elderly patients with early rectal cancer were retrospectively analyzed. They were divided into observation group(ESD,45 cases) and control group(EMR,45 cases),which accorded tooperation method,the basic dataes,pathological characteristics and operation related indicators of the two groups were compared. The prognosis of the two groups was recorded,the distribution characteristics of the incidence of complications in the observation group were analyzed. Results There were 45 cases of the observation group and control group,and there were no significant differences in tumor location,tumor stage,pathological classification,differentiation degree and tumor diameter between the two groups(P > 0. 05). The operation time of observation group was significantly longer than that of control group,the amount of bleeding during operation was significantly more than that of control group,and the total incidence of complications was significantly higher than that of control group,the difference were statistically significant.(P < 0. 05). The 3-year progression-free survival rate of observation group was significantly higher than that of control group(P < 0. 05),there was no significant difference in the 3 year survival rate between the two groups(P > 0. 05). The tumor diameter of the patients of complications in observation group was significantly higher than those of noncomplications,the difference was statistically significant(P < 0. 05). The ROC analysis showed that the AUC of tumor diameter to judge the complication in the observation group was 0. 718(β = 0. 087,95% CL = 0. 549-0. 888,P = 0. 026),the best cut-off value was2. 82 cm. Conclusion The ESD is more effective than EMR in prolonging the progression-free survival of elderly patients with early rectal cancer,while the complications of ESD are high,especially for patients whose tumor diameter exceeds 2. 82 cm,it should be paid to operative procedures.
Objective To study the effect of endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) to the elderly patients of early rectal cancer. Methods The clinical dataes of 90 elderly patients with early rectal cancer were retrospectively analyzed. They were divided into observation group(ESD,45 cases) and control group(EMR,45 cases),which accorded tooperation method,the basic dataes,pathological characteristics and operation related indicators of the two groups were compared. The prognosis of the two groups was recorded,the distribution characteristics of the incidence of complications in the observation group were analyzed. Results There were 45 cases of the observation group and control group,and there were no significant differences in tumor location,tumor stage,pathological classification,differentiation degree and tumor diameter between the two groups(P > 0. 05). The operation time of observation group was significantly longer than that of control group,the amount of bleeding during operation was significantly more than that of control group,and the total incidence of complications was significantly higher than that of control group,the difference were statistically significant.(P < 0. 05). The 3-year progression-free survival rate of observation group was significantly higher than that of control group(P < 0. 05),there was no significant difference in the 3 year survival rate between the two groups(P > 0. 05). The tumor diameter of the patients of complications in observation group was significantly higher than those of noncomplications,the difference was statistically significant(P < 0. 05). The ROC analysis showed that the AUC of tumor diameter to judge the complication in the observation group was 0. 718(β = 0. 087,95% CL = 0. 549-0. 888,P = 0. 026),the best cut-off value was2. 82 cm. Conclusion The ESD is more effective than EMR in prolonging the progression-free survival of elderly patients with early rectal cancer,while the complications of ESD are high,especially for patients whose tumor diameter exceeds 2. 82 cm,it should be paid to operative procedures.
引文
[1]李国东,董新舒.直肠癌外科治疗进展[J].中华肿瘤防治杂志,2015,22(5):402-406.
[2]黄群生,程克力,何晓生,等.青年结直肠癌病人临床病理学特征及预后分析[J].中国实用外科杂志,2018,38(6):666-671.
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[5]苏虹,刘明,陈进忠,等.内镜下黏膜切除术和内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的疗效分析[J].中华消化内镜杂志,2014,31(1):46-48.
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[8]刘卓,宋冰,李小寒.结直肠癌筛查影响因素的研究进展[J].中国医药导报,2014,11(2):41-43.
[9]孙学军,郑见宝.腹腔镜结直肠癌手术治疗研究进展[J].西安交通大学学报(医学版),2016,37(5):613-621.
[10]侯生槐,刘东博,白文启,等.早期直肠癌腔内微创手术的临床应用[J].实用医技杂志,2016,23(7):734-736.
[11]白东林,李沁,黄客增.结肠肛管吻合联合直肠癌根治术对低位直肠癌患者术后肛门功能的影响[J].结直肠肛门外科,2016,22(6):586-590.
[12]陈静,于红刚.内镜黏膜下剥离术治疗早期结直肠癌及其癌前病变的临床分析[J].中华消化内镜杂志,2016,33(3):151-154.
[13] Valentini V,Coco C,Gambacorta M A,et al. Evidence and research perspectives for surgeons in the european rectal cancer consensus conference(EURECA-CC2)[J]. Acta Chir Iugosl,2010,57(3):9-16.
[14]何祎,陆薇,童珠红.早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较[J].中国内镜杂志,2016,22(10):66-69.
[15] Wang J,Zhang X H,Ge J,et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors:A meta-analysis[J]. World J Gastroenterol, 2014,20(25):8282-8287.
[16]申星杰,刘亮,岳萌,等.老年早期结直肠癌患者内镜下黏膜剥离术安全性、疗效及术后整体生活质量调查[J].医学与哲学,2016,37(22):40-42,59.
[17]徐健,徐良,李林涛,等.影响内镜黏膜切除术治疗早期结直肠癌疗效的危险因素分析[J].中华消化外科杂志,2013,12(5):366-369.
[18] Hui-Min G,Xiao-Qi Z,Min C,et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer[J]. World J Gastroenterol,2014,20(18):5540-5547.
[19] Martelli MG, Duckworth LV, Draganov PV. Endoscopic submucosal dissection is superior to endoscopic mucosal resection for histologic evaluation of barrett’s esophagus and barrett’srelated neoplasia[J]. Am J Gastroenterol, 2016,111(6):902-903.
[20]倪阵,陈虹彬,刘炼炼,等.内镜下黏膜剥离术和内镜下黏膜切除术治疗153例结直肠癌前病变和早期癌的疗效对比[J].中华消化杂志,2016,36(2):122-124.
[21]梁丽,于妍斐,张继新,等. 113例早期结直肠癌及癌前病变内镜粘膜下剥离术标本处理及病理学评估[J].中华消化内镜杂志,2018,35(7):511-517.
[22]邵兰,岳辉,彭浒萍,等.内镜黏膜下剥离术诊治高度可疑结直肠癌或癌前病变及共聚焦激光显微内镜在随访中的价值[J].现代消化及介入诊疗,2014,19(2):85-90.
[23] Yoshida N,Naito Y,Murakami T,et al. High incidence of postoperative hemorrhage in colorectal endoscopic submucosal dissection during anticoagulant therapy[J]. IntJ Colorectal Dis,2016,31(8):1487-1488.
[24]廖斐,刘玉兰,沈磊,等.内镜黏膜下剥离术治疗直径大于20mm的结直肠侧向发育型肿瘤的临床研究[J].临床内科杂志,2016,33(4):239-242.
[2]黄群生,程克力,何晓生,等.青年结直肠癌病人临床病理学特征及预后分析[J].中国实用外科杂志,2018,38(6):666-671.
[3]柏愚,杨帆,马丹,等.中国早期结直肠癌筛查及内镜诊治指南(2014年,北京)[J].胃肠病学,2015,32(6):341-360.
[4] Terheggen G,Horn EM,VIieth M,et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia[J]. Gut,2017,66(5):783-793.
[5]苏虹,刘明,陈进忠,等.内镜下黏膜切除术和内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的疗效分析[J].中华消化内镜杂志,2014,31(1):46-48.
[6] Edge SB,Byrd DR,Compton CC,et al. AJCC cancer staging manual. 7th ed. New York:Springer,2010.
[7]姜春晓,沈永洲,张志浩.结直肠癌和癌前病变检出率与其危险因素关系[J].中国肿瘤,2017,26(11):868-873.
[8]刘卓,宋冰,李小寒.结直肠癌筛查影响因素的研究进展[J].中国医药导报,2014,11(2):41-43.
[9]孙学军,郑见宝.腹腔镜结直肠癌手术治疗研究进展[J].西安交通大学学报(医学版),2016,37(5):613-621.
[10]侯生槐,刘东博,白文启,等.早期直肠癌腔内微创手术的临床应用[J].实用医技杂志,2016,23(7):734-736.
[11]白东林,李沁,黄客增.结肠肛管吻合联合直肠癌根治术对低位直肠癌患者术后肛门功能的影响[J].结直肠肛门外科,2016,22(6):586-590.
[12]陈静,于红刚.内镜黏膜下剥离术治疗早期结直肠癌及其癌前病变的临床分析[J].中华消化内镜杂志,2016,33(3):151-154.
[13] Valentini V,Coco C,Gambacorta M A,et al. Evidence and research perspectives for surgeons in the european rectal cancer consensus conference(EURECA-CC2)[J]. Acta Chir Iugosl,2010,57(3):9-16.
[14]何祎,陆薇,童珠红.早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较[J].中国内镜杂志,2016,22(10):66-69.
[15] Wang J,Zhang X H,Ge J,et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors:A meta-analysis[J]. World J Gastroenterol, 2014,20(25):8282-8287.
[16]申星杰,刘亮,岳萌,等.老年早期结直肠癌患者内镜下黏膜剥离术安全性、疗效及术后整体生活质量调查[J].医学与哲学,2016,37(22):40-42,59.
[17]徐健,徐良,李林涛,等.影响内镜黏膜切除术治疗早期结直肠癌疗效的危险因素分析[J].中华消化外科杂志,2013,12(5):366-369.
[18] Hui-Min G,Xiao-Qi Z,Min C,et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer[J]. World J Gastroenterol,2014,20(18):5540-5547.
[19] Martelli MG, Duckworth LV, Draganov PV. Endoscopic submucosal dissection is superior to endoscopic mucosal resection for histologic evaluation of barrett’s esophagus and barrett’srelated neoplasia[J]. Am J Gastroenterol, 2016,111(6):902-903.
[20]倪阵,陈虹彬,刘炼炼,等.内镜下黏膜剥离术和内镜下黏膜切除术治疗153例结直肠癌前病变和早期癌的疗效对比[J].中华消化杂志,2016,36(2):122-124.
[21]梁丽,于妍斐,张继新,等. 113例早期结直肠癌及癌前病变内镜粘膜下剥离术标本处理及病理学评估[J].中华消化内镜杂志,2018,35(7):511-517.
[22]邵兰,岳辉,彭浒萍,等.内镜黏膜下剥离术诊治高度可疑结直肠癌或癌前病变及共聚焦激光显微内镜在随访中的价值[J].现代消化及介入诊疗,2014,19(2):85-90.
[23] Yoshida N,Naito Y,Murakami T,et al. High incidence of postoperative hemorrhage in colorectal endoscopic submucosal dissection during anticoagulant therapy[J]. IntJ Colorectal Dis,2016,31(8):1487-1488.
[24]廖斐,刘玉兰,沈磊,等.内镜黏膜下剥离术治疗直径大于20mm的结直肠侧向发育型肿瘤的临床研究[J].临床内科杂志,2016,33(4):239-242.
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