本文選題：ESD + 結(jié)直腸病變　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:探討ESD治療老年人結(jié)直腸病變的療效與安全性,分析其影響因素。方法:回顧性分析2011年5月至2016年12月在浙江大學(xué)附屬第一醫(yī)院行ESD治療的240例(249個(gè)病灶)結(jié)直腸黏膜及黏膜下病變患者的臨床及病理資料,比較老年人ESD的成功率、治療效果及并發(fā)癥發(fā)生情況與非老年人之間的差異。結(jié)果:早期結(jié)直腸癌患者中有癥狀者占69.2%,老年人占76.5%。黏膜下病灶主要位于直腸(86.96%);黏膜病變主要位于直腸(45.56%)、乙狀結(jié)腸(21.11%)、升結(jié)腸(19.44%)。老年人病理類型以低級別上皮內(nèi)瘤變與高級別上皮內(nèi)瘤變?yōu)橹?非老年人則以低級別上皮內(nèi)瘤變與類癌為主�？稍u估大小的237例病灶中,黏膜下隆起69例,平均直徑0.87±0.49cm;黏膜病變180例,平均直徑為2.89±1.52cm。不同病理類型病變的大小在老年人與非老年人之間無顯著性差異。老年人結(jié)直腸ESD術(shù)的成功率(97.0%)稍高于非老年人(96.6%),整塊切除率(87.2%)低于非老年人(91.5%),完全切除率(72.9%)低于非老年人(80.2%),治愈性切除率(67.7%)低于非老年人(72.4%),并發(fā)癥發(fā)生率(6.0%)與非老年人(6.0%)相近。老年人ESD術(shù)后平均住院時(shí)間(5.63±2.76天)高于非老年人(5.10±1.92天)(P=0.043)。病灶長徑(P=0.032)、年齡(P=0.036)為發(fā)生并發(fā)癥的相關(guān)因素,而病灶位置、病理類型與發(fā)生并發(fā)癥無相關(guān)性(p0.05)。病灶長徑和年齡同樣也是分塊切除的相關(guān)因素(P長徑=0.036,P年齡=0.048)。黏膜病變術(shù)后病理標(biāo)本側(cè)緣和(或)基底陽性的發(fā)生率為14.1%(22/156),黏膜下病變?yōu)?7.9%(12/67)。切緣陽性的黏膜下病灶平均直徑為0.90±0.33cm,與切緣陰性的黏膜下病灶0.79±0.35cm無顯著性差異(P=0.303)。切緣陽性的黏膜病變的平均直徑為2.80±1.06cm,顯著大于切緣陰性的黏膜病灶2.66±1.33cm(P=0.000)。ESD術(shù)后總復(fù)發(fā)率為0.0%～0.1%。結(jié)論:ESD治療老年人結(jié)直腸病變具有良好的療效與安全性。病灶越大,患者年齡越大,發(fā)生并發(fā)癥、分塊切除的可能性越大。與黏膜病變相比,黏膜下病變切緣陽性的可能性更大。對于黏膜病變,病灶越大、浸潤深度越深,切緣陽性的可能性越大。
[Abstract]:Objective: to investigate the efficacy and safety of ESD in the treatment of colorectal lesions in the elderly and analyze its influencing factors. Methods: the clinical and pathological data of 240 patients (249 lesions) with colorectal mucosal and submucosal lesions treated with ESD in the first affiliated Hospital of Zhejiang University from May 2011 to December 2016 were analyzed retrospectively. The success rate of ESD in the elderly was compared. The difference between the effect of treatment and the occurrence of complications was compared with that of non-elderly people. Results: 69.2% of the patients with early colorectal cancer and 76.55% of the elderly had symptoms. The submucosal lesions were mainly located in the rectum (86.96), the mucosal lesions in the rectum (45.56), the sigmoid colon (21.11) and the ascending colon (19.44). The pathological types of the elderly were mainly low grade intraepithelial neoplasia and high grade intraepithelial neoplasia, while non-elderly patients were mainly low grade intraepithelial neoplasia and carcinoid. Of the 237 lesions, 69 were submucosal eminence with an average diameter of 0.87 鹵0.49 cm, and 180 had mucosal lesions with an average diameter of 2.89 鹵1.52 cm. There was no significant difference in the size of different pathological types between the elderly and the non-elderly. The successful rate of colorectal ESD in the elderly was slightly higher than that in the non-elderly patients (96.6%) and the whole resection rate was 87.2%) lower than that in the non-elderly group (91.5%, complete resection rate 72.9%) lower than that in the non-elderly group (80.22%), and the cure rate was 67.7%) lower than that in the non-elderly group (72.4%, the complication rate was 6.0), and the incidence of complications was similar to that in the non-elderly group (6.0). The average hospitalization time after ESD in the elderly was 5.63 鹵2.76 days, which was higher than that in the non-elderly patients (5.10 鹵1.92 days). P0. 032, age (P0. 036) were the related factors of complications, but there was no correlation between the location and pathological type of lesions and the occurrence of complications (p0. 05). The length and age of lesion were also related factors of segmental resection. The incidences of positive lateral margin and / or basal base in pathological specimens after mucosal lesions were 14.1or 22 / 156g, and 17.9 / 67 / 67 for submucosal lesions. The mean diameter of submucosal lesions with positive margin was 0.90 鹵0.33 cm, and there was no significant difference between 0.79 鹵0.35cm of submucosal lesions with negative margin. The average diameter of mucosal lesions with positive margin was 2.80 鹵1.06cm, which was significantly larger than that of negative lesions (2.66 鹵1.33cm(P=0.000).ESD). Conclusion: ESD is effective and safe in the treatment of colorectal diseases in the elderly. The older the lesion, the older the patient, the more likely the complication and the greater the possibility of segmental resection. Compared with mucosal lesions, submucosal lesions were more likely to be positive. For mucosal lesions, the larger the lesion, the deeper the depth of invasion and the greater the possibility of positive margin.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574

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