Sharing Single Surgeon Experience of Learning Endoscopic Submucosal Dissection for Colorectal Lesions

單一醫師、內視鏡黏膜下切除之經驗分享

黃暐聖(Wei-Sheng Huang) ； 楊靖國(Ching-Kuo Yang) ； 林秉緯(Ping-Wei Lin) ； 孫文俊(Wen-Chun Sun) ； 陳建勳(Jian-Syun Chen) ； 賴正大(Cheng-Ta Lai) ； 蔡伯立(Po-Li Tsai) ； 梁偉雄(Wai-Shung Leung) ； 許希賢(His-Hsien Hsu) ； 陳明仁(Ming-Jen Chen) ； 劉建國(Chien-Kuo Liu)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 187-194

https://doi.org/10.6312/SCRSTW.202009_31(3).10908

摘要

Background. Endoscopic submucosal dissection (ESD) is used for re-moving colorectal lesions. It is a very technically demanding but less widespread therapy. We try to demonstrate our single-surgeon experience in learning this operation. Method. We reviewed patient from October 2015 to December 2018 who received the operation. 18 patients were enrolled. Patient profiles, lesion size, location, pathology report, en bloc resection, margin involvement, operating time, and complications were analyzed. Results. The lateral spreading tumors treated with endoscopic submucosal dissection located at the cecum (n = 4), ascending colon (n = 3), trans-verse colon (n = 2), descending colon (n = 1), sigmoid colon (n = 5) and rectum (n = 3). The average size of the tumors was 2.46 cm (range, 1 to 3.7cm). The en bloc resection rate was 83.33%, and the complete resection rate was 61.1%. Only one patients experienced micro-perforation, and the overall complication rate was 5.56%. Positive correlation was noted between lesion size and operation time (co-efficient value = 0.33). Conclusion. ESD is a difficult procedure. Small lesions can decreased operative duration. Cecum is more challenging because of nearby structure. Through experience accumulation, improving en bloc and R0 resection rate can be seen.

關鍵字

ESD ； Endoscopic submucosal dissection ； Colorectal polyps ； Learning curve

並列摘要

背景：大腸鏡黏膜下切除可用於較大的大腸直腸瘜肉，執行難度高而且比較不普及，本篇多個案分析研究希望藉由單一外科醫師手術經驗提供初學者參考。方法：收集2015年至2018年共18個案例，針對個案分類，瘜肉的病理分析，以及術後追蹤，整合出學習曲線以及手術成果的進步。成果：本研究的病灶位置位在盲腸（4例）、升結腸（3例）、橫結腸（2例）、降結腸（1例）、乙狀結腸（5例）及直腸（3例）。平均大小為2.46公分。完整切除比例為83.33%。邊緣陰性率為61.1%。僅一例於術後有輕微腸穿孔之併發症，併發症發生率為5.56%。病灶大小與手術時間為正相關，相關係數為0.33。結論：黏膜下切除雖然是一個難度高的手術。較小的病灶可以縮短手術時間。盲腸因為鄰近的構造，會增加手術的難度。藉由經驗的累積，在完整切除以及邊緣侵犯的比例都能進步。

並列關鍵字

黏膜下切除 ； 大腸直腸瘜肉 ； 學習曲線

參考文獻

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