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

Factors influencing the efficacy of endoscopic mucosal resection for early colorectal cancer

    摘要
  • 摘要:
    目的 探讨影响内镜黏膜切除术(EMR)治疗早期结直肠癌患者效果的临床危险因素。
    方法 回顾性分析2005年1月至2012年6月第二军医大学附属长征医院收治的140例行EMR治疗的早期结直肠癌患者的临床资料。早期结直肠癌肿瘤直径<20 mm的隆起型和直径<5 mm的凹陷型选择EMR；当早期结直肠癌肿瘤直径≥30 mm难以一次切除时行内镜下分块黏膜切除术。收集患者的性别、年龄，肿瘤部位、数目、直径、形态、切除方式、浸润深度、组织分化、淋巴管或血管浸润、切缘特点和治愈情况等资料，并根据治愈情况分为完全治愈组和不完全治愈组。单因素分析采用X2检验，应用Logistic多元回归模型进行多因素分析。
    结果 140例患者的143个肿瘤中，125个整块切除，18个分块切除。90个肿瘤为黏膜内癌，53个为黏膜下癌；96个肿瘤为高分化，37个为中分化，10个为低分化；135个肿瘤无淋巴管或血管浸润，8个有淋巴管或血管浸润。118个肿瘤为R0切除，15个为R1切除，8个为R2切除，2个为Rx切除(无法评价切缘是否有癌细胞残留)。2例Rx切除者排除于本研究，完全治愈组患者98例，共101个肿瘤，不完全治愈组患者40例，共40个肿瘤。单因素分析结果显示：肿瘤部位、肿瘤形态和切除方式是影响早期结直肠癌患者EMR治疗效果的危险因素(X2=7.523,16.280,4.156,P<0.05)。多因素分析结果表明：肿瘤位于结肠近侧、表面隆起凹陷型和分块切除是影响早期结直肠癌患者EMR治疗效果的独立危险因素(OR=7.219,6.115,5.211,P<0.05)。
    结论 肿瘤位于结肠近侧和表面隆起凹陷型的早期结直肠癌采用EMR治疗不易获得完全治愈，并且手术方式要尽量避免分块黏膜切除术。

     

    Abstract:
    Objective  To investigate the clinical risk factors of endoscopic mucosal resection (EMR) for early colorectal cancer.
    Methods The clinical data of 140 patients with early colorectal cancer who received EMR at the Changzheng Hospital of Second Military Medical University from January 2005 to June 2012 were retrospectively analyzed. EMR was applied for patients with early colorectal cancer with diameter lesser than 20 mm (protrusive lesions) or 5 mm (depressed lesions). If the diameter of the early colorectal cancer was above 3 cm and can not be resected at one time, endoscopic piecemeal mucosal resection was adopted. Clinicopathological factors including gender, age, tumor location, number, diameter, shape, resection type, depth of tumor invasion, tissue differentiation, lymphatic or vascular invasion, excision degree and curability were retrospectively analyzed. All the patients were divided into the complete cure group and the incomplete cure group. Univariate and multivariate analysis were done using the chi square test and Logistic regression model, respectively.
    Results Of the 143 lesions, en bloc resection was done in 125 lesions, and piecemeal resection in 18 lesions.There were 90 intramucosal carcinomas and 53 submucosal carcinomas. The numbers of high, moderate and low differentiated colorectal cancer were 96, 37 and 10. Lymphatic or vascular invasion was found in 8 lesions. The numbers of R0, R1, R2 and Rx resection were 118, 15, 8 and 2. Two patients with Rx resection were excluded from this study. There were 98 patients (101 lesions) in the complete cure group, and 40 patients (40 lesions) in the incomplete cure group. The results of univariate analysis showed that tumor location, shape and resection type were the risk factors influencing the efficacy of EMR for early colorectal cancer (X2=7.523, 16.280, 4.156, P<0.05). The results of multivariate analysis showed that tumor located at the proximal colon, superficial protrusive and depressed type and piecemeal resection were the independently risk factors influencing the efficacy of EMR (OR=7.219, 6.115, 5.211, P<0.05).
    Conclusions EMR is not easy to achieve complete cure for early colorectal cancer with superficial protrusive and depressed type or located at the proximal colon. Endoscopic piecemeal mucosal resection should try to avoid.

     

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