Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors
Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors
复制标题
DOI：
10.1007/s00464-011-2075-5
复制
发表时间：
2012-06-01
影响因子：
3.1
通讯作者：
Youk, Eui Gon
中科院分区：
文献类型：
--
作者：
Lee, Eun-Jung;Lee, Jae Bum;Youk, Eui Gon
在内窥镜下黏膜下剥离(ESD)治疗结直肠肿瘤的过程中可能存在的结肠穿孔的风险是广泛应用的障碍。2006年10月至2010年11月，连续499例(平均年龄60.0+/-A11.3岁)接受ESD治疗的无蒂结直肠肿瘤患者接受ESD治疗，分析其发生穿孔的风险和预测因素。首先，评估穿孔的发生率和临床病程。其次，分析了与患者相关的变量(年龄、性别、阿司匹林或抗血小板药物的病史和合并症)、内窥镜变量(肿瘤大小、位置和类型)、手术相关变量(手术经验、手术时间和黏膜下注射的材料)和病理诊断。全组切除率为95.0%。499例患者中有37例发生穿孔(7.4%)。34例患者可以成功地进行保守治疗。肿瘤的类型(侧向扩散)和肿瘤的位置(右侧结肠)、每位内窥镜医生手术经验较少(<；100例)以及粘膜下注射不透明质酸与穿孔的发生率较高(均为<；0.05)。多因素分析显示，肿瘤侧向扩散型[优势比(OR)4.10，95%可信区间(CI)1.17~14.34]和粘膜下注射透明质酸(OR 0.31，95%CI 0.13~0.72)是独立的预测因素，穿孔率为7.4%，大部分病例可以通过非手术治疗获得成功。对于侧向发育型的肿瘤，在黏膜下清扫时需要更加谨慎，长时间的粘膜下垫层对于防止穿孔是重要的。
The possible risk of colonic perforation during endoscopic submucosal dissection (ESD) for colorectal tumors is a barrier to wide application. This retrospective study was performed to evaluate the risk and the predictive factors for perforation during ESD procedure.Between October 2006 and November 2010, a total of 499 consecutive patients (mean age 60.0 +/- A 11.3 years) who underwent ESD for large-sized (a parts per thousand yen20 mm), nonpedunculated colorectal tumor were analyzed. First, incidence rate and clinical course of perforation were evaluated. Second, patient-related variables (age, sex, history of aspirin or antiplatelet agents, and comorbidity), endoscopic variables (tumor size, location, and type), procedure-related variables (experience of procedures, procedure time, and materials of submucosal injection), and pathologic diagnosis were analyzed.The mean size of the lesions was 28.9 mm. The overall en bloc resection rate was 95.0%. Perforation occurred in 37 out of 499 patients (7.4%). Thirty-four patients could be successfully treated conservatively. The type (laterally spreading tumor) and the location (right-sided colon) of the tumors, less experience of the procedure (< 100 cases) in each endoscopist, and submucosal injection without hyaluronic acid were associated with higher frequency of perforation (all < 0.05). On multivariate analysis, laterally spreading type of tumor [odds ratio (OR) 4.10, 95% confidence interval (CI) 1.17-14.34] and submucosal injection with hyaluronic acid (OR 0.31, 95% CI 0.13-0.72) were independent predictive factors.Perforation rate was 7.4%, and most cases could be successfully managed nonsurgically. In case of laterally spreading type of tumor, more caution is needed during submucosal dissection and long-lasting submucosal cushion is important for preventing perforation.