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内镜下分片冷切除术治疗最大径≥20 mm结直肠侧向发育型肿瘤的安全性和有效性

Safety and efficacy of piecemeal cold snare polypectomy for ≥20 mm colorectal laterally spreading tumor

    摘要
  • 摘要:
    目的 评价内镜下分片冷切除术治疗最大径≥20 mm结直肠侧向发育型肿瘤(LST)的安全性和有效性。
    方法 前瞻性纳入2021年11月至2022年6月接受诊治的最大径≥20 mm的结直肠LST患者。病变黏膜下注射染色剂后，采用圈套器进行内镜下分片冷切除。主要研究终点指标为内镜切除术后6个月病变复发率；次要研究终点指标为不良事件(如出血、穿孔)发生率等。
    结果 共13例患者纳入研究，病灶平均最大径为2.3(2~3.3) cm。13例肿瘤均成功完成内镜下分片冷切除，平均分片4.2(2~7)片，手术平均时间为16.1(7~31)min。术中出血1例，经金属夹夹闭成功止血；未出现深层损伤、迟发性出血和迟发性穿孔。所有患者均于术后第6个月接受监测性结肠镜检查，均未发现局部复发及远处转移。
    结论 内镜下分片冷切除术治疗最大径≥20 mm结直肠LST安全、有效。

     

    Abstract:
    Objective To investigate the safety and efficacy of piecemeal cold snare polypectomy (p-CSP) for ≥20 mm large colorectal laterally spreading tumor (LST).
    Methods Eligible patients with colorectal LST with large diameter ≥20 mm were prospectively included between November 2021 and June 2022. After submucosal injection of staining agent in the lesion, the snare was used to perform endoscopic p-CSP. The primary outcome was the lesion recurrence within 6 months after p-CSP. The secondary outcome was adverse events (such as bleeding, perforation) happening, etc..
    Results A total of 13 patients were included, and the average diameter of the lesions was 2.3 (2-3.3) cm. All tumors were successfully removed by p-CSP with 16.1 (7-31) minutes of average operation time, and the average number of slices was 4.2 (2-7). One case of intraoperative bleeding was successfully managed by metal clips. There was no intraoperative deep injury, delayed bleeding or delayed perforation. All patients received surveillance colonoscopy inspection 6 months after operation, and there was no local recurrence or distant metastasis.
    Conclusion p-CSP might be safe and effective for colorectal LST≥20 mm.

     

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