Objective: To compare the clinical benefits of classic endoscopic submucosal dissection (ESD) and hybrid ESD for the treatment of colorectal epithelium-derived tumors. Methods: The current investigation was a retrospective multicenter study of 418 patients who underwent ESD between January 2015 and April 2021 at Beijing Jishuitan Hospital. The patients were assigned to one of two groups based on the surgical procedure they underwent; a classic ESD group or a hybrid ESD group. The primary outcome was the rate of en bloc resection and complete resection. SPSS 26.0 was used for statistical analysis. Homogeneity of variance was assessed via Cochran's test. Normally distributed data with homogeneity of variance were analyzed via the t-test for independent samples. Non-normally distributed data and data with unequal variance were analyzed via the Kruskal-Wallis non-parametric test. Categorical data were analyzed via the Chi-square test or Fisher's exact test. Multivariable assessment was performed via logistic regression analysis. Results: The en bloc resection rates [89.4% (84/94) vs. 87.0% (194/223), χ2=0.34, P=0.558] and complete resection rates [85.1% (80/94) vs. 82.1% (183/223), χ2=0.33, P=0.510] were similar. Compared with classic ESD, procedures were shorter in the hybrid ESD group [22(7, 213) vs. 47(12, 680) min, Z=0.23, P<0.001], dissection was completed more rapidly [0.14(0.02, 0.32) vs. 0.10(0.02, 0.41) cm2/min, Z=0.08, P<0.001], and there was a higher rate of perforation (9.6% vs. 2.2%, χ2=2.67, P=0.006). Laterally spreading tumor granular type nodular mixed, non-granular type pseudo-depressed, flat-elevated type (odds ratio 2.826, P=0.012), and tumor location (odds ratio 6.970, P=0.005) were independently associated with complete resection in the hybrid ESD group. Conclusion: Classic ESD and hybrid ESD had similar en bloc and complete resection rates for colorectal epithelium-derived tumors, but hybrid ESD had shorter operation times. With respect to hybrid ESD, factors associated with failure of complete resection included lesion type and crossing tissue boundaries.
目的： 比较经典内镜黏膜下剥离术（ESD）与简化ESD在治疗结直肠上皮来源性肿瘤中的临床效益。 方法： 回顾性分析2015年1月至2021年4月在北京积水潭医院接受ESD的患者418例。根据手术方式分为经典ESD组和简化ESD组，研究指标包括病变的整块切除率和完全切除率。用SPSS 26.0软件进行统计学分析，方差齐的正态分布数据采用独立样本t检验进行分析。方差不齐或非正态分布的数据使用Kruskal-Wallis非参数检验进行分析。分类数据用卡方检验或Fisher精确检验进行分析。通过多因素logisitc回归分析得出相关危险因素。 结果： 简化ESD组与经典ESD组相比，整块切除率［89.4%（84/94）比 87.0%（194/223），χ2=0.34，P=0.558］和完全切除率［85.1%（80/94）比82.1%（183/223），χ2=0.33，P=0.510］差异无统计学意义。简化ESD手术时间更短［22（7，213）比 47（12，680）min，Z=0.23，P<0.001］，剥离速度更快［0.14（0.02，0.32）比0.10（0.02，0.41）cm2/min，Z=0.08，P<0.001］，穿孔率更高［9.6%（9/94）比2.2%（5/223），χ2=2.67，P=0.006］。侧向发育型肿瘤中的结节混合型、假凹陷型、平坦隆起型（OR=2.826，P=0.012）及肿瘤是否跨越组织边界（OR=6.970，P=0.005）是简化ESD组能否完全切除的影响因素。 结论： 简化ESD与经典ESD相比，治疗结直肠上皮来源性肿瘤的完全切除和整块切除率相似，但手术时间较短。简化ESD完全切除失败的影响因素包括病变大体类型和跨越组织边界。.