摘要
目的探讨内镜黏膜下剥离术(ESD)治疗直肠神经内分泌瘤(RNET)手术时间的影响因素。方法回顾性纳入于2012年8月至2020年8月在郑州大学第一附属医院接受ESD治疗的96例RNET患者(98处病灶)。收集患者的一般情况(性别、年龄)、病变的内镜学特征(隆起形态、颜色、病灶部位、表面凹陷情况)、病理学特点(病灶大小、病理分级、浸润深度、标本切缘、淋巴血管等的侵犯情况)以及手术时间。用单因素分析寻找ESD手术时间≥30 min的影响因素,将有统计学差异的因素纳入多因素logistic回归分析独立危险因素。结果本研究中男女比例为1.59∶1,平均年龄为(48.04±10.69)岁。ESD手术时间为17.00(10.00,27.00)min,病灶长轴为0.50(0.40,0.80)cm,病灶距肛门距离为7.00(5.00,8.00)cm。病灶整块切除率、完整切除率分别为100%、92.86%。单因素分析显示患者年龄、性别、病变位置、病变颜色、病灶浸润深度、病理分级均不是影响ESD手术时长的因素(P>0.05),病灶隆起形态、病灶长轴、病灶黏膜表面凹陷情况与ESD手术时长相关(P<0.05)。多因素logistic回归分析显示病灶长轴≥1 cm(OR=8.353,P=0.007)、病灶黏膜表面凹陷(OR=8.117,P=0.012)是手术≥30 min的独立危险因素。结论直肠ESD治疗早期RNET是安全有效的。病灶长轴≥1 cm、病灶黏膜表面凹陷是手术≥30 min的独立危险因素。术前通过明确上述特征,评估手术难度,有助于医患沟通,合理安排手术及指导术后护理、治疗等。
Objective To investigate the risk factors for procedure time of endoscopic submucosal dissection(ESD)for rectal neuroendocrine tumor(RNET).Methods A total of 96 patients(98 rectal lesions)who received ESD for RNET in the First Affiliated Hospital of Zhengzhou University from August 2012 to August 2020 were retrospectively analyzed.Clinical information including the general information(gender,age),endoscopic characteristics(morphology,color,location),pathological characteristics(lesion size,pathology grade,infiltration depth,edge,etc.)and operation time were collected.Univariate analysis was used to find the risk factors of ESD operation time,and logistic regression analysis was performed on the factors with statistical differences in univariate analysis to find the independent risk factors.Results The age of 96 patients was(48.04±10.69)years old,male/female ratio was 1.59∶1.The median time of ESD operation was 17.00(10.00,27.00)min,diameter of the lesion was 0.50(0.40,0.80)cm,distance of the lesion was 7.00(5.00,8.00)cm from the anus.En bloc resection rate,and complete resection rate were 100%,92.86%.Univariate analysis showed age,gender,location,color,infiltration depth and pathology grade were not related to the length of time of ESD surgery(P>0.05),while morphology,size and depression of lesion were risk factors(P<0.05).In multivariate logistic regression,diameter≥1 cm(OR=8.353,P=0.007)and depression of lesion mucosa(OR=8.117,P=0.012)were independent risk factors for the operation time≥30 minutes.Conclusion Rectal ESD is safe and effective for early RNET.The diameter of the lesion≥1 cm and depression of lesion mucosa were independent risk factors for the operation time≥30 minutes of ESD.Preoperative evaluation of the difficulty of the operation by defining the above characteristics is conducive to doctor-patient communication,reasonable arrangement of the operation,and guidance of postoperative care and treatment.
作者
金丽君
张惠霞
王小月
赵瑞敏
JIN Lijun;ZHANG Huixia;WANG Xiaoyue;ZHAO Ruimin(Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2021年第8期1366-1369,共4页
Henan Medical Research
关键词
直肠神经内分泌瘤
内镜黏膜下剥离术
手术时间
危险因素
rectal neuroendocrine tumor
endoscopic submucosal dissection
operation time
risk factors
