早期结直肠癌超声内镜检查及内镜黏膜下剥离术的临床价值

    Clinical value of endoscopic ultrasonography and endoscopic submucosal dissection in early colorectal cancer

    • 摘要:
      目的分析采用超声内镜检查对早期结直肠癌病人的诊断价值及内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)的临床治疗效果。
      方法回顾性分析2018年10月至2019年12月收治的早期结直肠癌病人120例临床资料,病人均接受超声内镜检查及ESD。以术后病理结果作为诊断金标准,分析超声内镜检查在早期结直肠癌病人中的诊断价值,并对ESD手术时间、病灶、病变直径及并发症发生情况随访情况进行记录。
      结果病理结果显示:Tm期53例,Tsm1期42例,Tsm2期25例;超声内镜检出结果显示:Tm期51例,Tsm1期41例,Tsm2期28例。超声内镜对Tm期诊断敏感度90.57%,特异度95.52%,诊断符合率93.33%;Tsm1期诊断敏感度78.57%,特异度89.74%,诊断符合率85.83%;Tsm2期敏感度88.00%,特异度93.68%,符合率92.50%;经Kappa一致性检验显示:超声内镜的Kappa系数达0.780。根据病人病理分期进行分组,手术时间:Tm期 < Tsm1期 < Tsm2期(P < 0.01);病变直径在Tm期、Tsm1期、Tsm2期组间差异有统计学意义(P < 0.01)。不同分期病人各种并发症发生率及总发生率,差异无统计学意义(P>0.05)。
      结论超声内镜检查对早期结直肠癌病人临床疾病分期具有较高诊断价值。采用ESD治疗的早期结肠癌病人术后恢复均较好,但临床分期越高病人手术时间越长及病灶病变范围也越大。

       

      Abstract:
      ObjectiveTo analyze the diagnostic value of endoscopic ultrasonography in patients with early colorectal cancer and the clinical therapeutic effect of endoscopic submucosal dissection(ESD).
      MethodsThe clinical data of 120 patients with early-stage colorectal cancer admitted from October 2018 to December 2019 were retrospectively analyzed.All patients received endoscopic ultrasonography and ESD.Taking postoperative pathological results as the diagnostic gold standard, the diagnostic value of endoscopic ultrasonography in patients with early colorectal cancer was analyzed, and the ESD operation time, lesion, lesion diameter and complication follow-up were recorded.
      ResultsThe pathological results showed that 53 cases were in Tm stage, 42 cases were in Tsm1 stage, and 25 cases were in Tsm2 stage.The diagnostic sensitivity of endoscopic ultrasonography for Tm stage was 90.57%, the specificity was 95.52%, and the diagnostic coincidence rate was 93.33%;the diagnostic sensitivity of Tsm1 stage was 78.57%, the specificity was 89.74%, and the diagnostic coincidence rate was 85.83%;the sensitivity of Tsm2 stage was 88.00%, the specificity was 93.68%, and the coincidence rate was 92.50%, the Kappa consistency test showed that the Kappa coefficient of endoscopic ultrasonography was 0.780.The patients were grouped according to the pathological stage, and the operation time was as follows: Tm stage < Tsm1 stage < Tsm2 stage(P < 0.01);there were statistically significant differences in the diameter of lesions between the groups in Tm, Tsm1, and Tsm2 stages(P < 0.01).There was no significant difference in the incidence and total incidence of various complications in patients of different stages(P>0.05).
      ConclusionsEndoscopic ultrasonography has a high diagnostic value in the clinical stage of early colorectal cancer.Patients with early colon cancer treated with ESD have good postoperative recovery.However, the patients with a higher clinical stage have a longer operation time and a more extensive range of lesions.

       

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