结直肠瘤的内镜下粘膜剖析:局部复发和长期监测的风险因素
Taishi Okumura1, Takemasa Hayashi1, Shin-Ei Kudo1
1Digestive Disease Center Showa University Northern Yokohama Hospital Kanagawa Japan.
DEN open
|July 5, 2023
概括
对结直肠瘤进行内镜下粘膜切割 (ESD) 是有效的,但现在已经确定了局部复发风险因素. 损伤大小,切除完整度和纤维化严重程度预测复发,指导监测.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 在瘤学瘤学.
背景情况:
- 内镜下粘膜切割 (ESD) 是结直肠瘤块切除的关键技术.
- 确定ESD后局部复发的风险因素对于优化患者管理和监测策略至关重要.
研究的目的:
- 评估结直肠瘤的内镜下粘膜切割 (ESD) 后与局部复发相关的临床病理风险因素.
- 在高风险患者中建立针对性监测协议的基础.
主要方法:
- 在2003年9月至2019年12月期间,对1344名接受ESD治疗的患者进行了1539次结直肠病变的回顾性分析.
- 研究临床病理因素,包括病变大小,切除方法,切除完整性和组织纤维化,与局部复发发病率相关.
主要成果:
- 实现了高分块切除率 (98.6%) 和R0切除率 (97.2%).
- 在72个月的中位数随访期间,在0.5%的患者中观察到局部复发.
- 复发的重要危险因素包括大损伤大小 (≥40毫米),零碎切除,非R0切除,不完整的组织切除和严重纤维化 (F2).
结论:
- 在结直肠ESD后出现局部复发的五个关键风险因素已被确定.
- 患有这些风险因素的患者需要仔细监测结肠镜,以监测复发情况.
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