Objective: To evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early low rectal cancer and precancerous lesions. Methods: Inclusion criteria: (1) Distance from the lower margin of tumor to the anal was ≤ 5 cm. (2) Early low rectal cancers were any size rectal epithelial tumors with infiltration depth limited to the mucosa and submucosa, which were diagnosed by postoperative pathology as high-grade intraepithelial neoplasia or adenocarcinoma of the rectum with infiltration depth of intramucosal or submucosal cancer (M or SM stage). (3) Precancerous lesions included adenoma and low-grade intraepithelial neoplasia of the rectum. (4) Patients received ESD treatment. Patients with tumor invasion depth over submucosa by pathology were excluded. From January 2008 to January 2018, 63 patients meeting the above criteria in Peking University First Hospital were enrolled in this descriptive cohort study. The disease characteristics, clinical manifestations, pathological types, treatment time, hospitalization time, en bloc resection rate (resection of the whole lesion), complete resection rate (both the horizontal and vertical incision margins were negative), postoperative complications and follow-up results were analyzed. Cummulative survival rate was calculated by Kaplan-Meier. Results: The diameter of the lesion was (29.0±23.4) mm and the distance from the lesion to the anus was (2.7±1.8) cm. The median operation time was 45.0 (range, 10.0 to 360.0) minutes, the median hospitalization time was 3.0 (range, 2.0 to 12.0) days, en bloc resection rate was 100%, complete resection rate was 96.8% (61/63), and 1 case (1.6%) had postoperative bleeding. The follow-up rate was 87.3% (55/63) and the median follow-up time was 57.9 (range, 15.6 to 121.1) months. No local recurrence was found during the follow-up period and the 5-year survival rate was 100%. Conclusion: Short- and long-term efficacy of ESD are quite good in the treatment of patients with early low rectal cancer and precancerous lesions.
目的： 探讨内镜黏膜下剥离术（ESD）治疗低位直肠早癌及癌前病变的临床近、远期疗效。 方法： 研究对象：（1）肿瘤下缘距肛门≤5 cm；（2）低位直肠早癌，即浸润深度局限于黏膜及黏膜下层的任意大小的直肠上皮性肿瘤，术后病理确诊为直肠高级别上皮内瘤变或腺癌，且浸润深度为黏膜内癌或黏膜下癌（M或SM期）；（3）癌前病变，包括病理为腺瘤及直肠低级别上皮内瘤变；（4）接受ESD治疗。回顾性纳入2008年1月至2018年1月期间北京大学第一医院收治的符合上述要求的63例患者的病历资料，采用描述性病例系列研究的方法，分析患者的病变特征、临床表现、病理类型、治疗时间、住院时间、整块切除率（一次性整块切除病灶并获得整块标本）、完全切除率（整块切除标本的水平和垂直切缘均为阴性）、术后并发症及随访结果。生存率用Kaplan-Meier法计算。 结果： 本组患者的病灶直径（29.0±23.4）mm，病变下缘距肛门距离（2.7±1.8）cm。中位手术时间45.0（10.0~360.0）min，中位住院时间3.0（2.0~12.0）d，肿瘤整块切除率100%，完全切除率96.8%（61/63）；术后出血1例（1.6%）。随访率87.3%（55/63），中位随访时间57.9（15.6~121.1）个月，期间无患者出现局部复发，术后5年生存率100%。 结论： ESD治疗低位直肠早癌及癌前病变近、远期疗效良好。.
Keywords: Early rectal neoplasms, low; Endoscopicsubmucosal dissection; Precancerous conditions.