内镜下黏膜剥离术治疗早期直肠癌及癌前病变的疗效及对肛肠动力学的影响

Effects of endoscopic submucosal dissection on anorectal kinetics in patients with early colorectal cancer and precancerous lesions

目的研究内镜下黏膜剥离术(ESD)与内镜下黏膜切除术(EMR)对早期直肠癌(ERC)及癌前病变(PL)患者血管细胞黏附分子-1(VCAM-1)、细胞间黏附分子-1(ICAM-1)及肛肠动力学的影响。方法将80例ERC及PL患者按照随机数字表法分为试验组(n=40)与对照组(n=40),对照组行EMR治疗,试验组行ESD治疗。观察两组围手术期指标及病灶切除情况;术前、术后7天检测血清VCAM-1、ICAM-1水平;术前、术后1个月、术后6个月检测直肠静息压(RRP)、肛管静息压(ARP)、直肠肛管抑制反射阈值(AIRT)、肛管蠕动波频率(APWF)、肛管最大收缩压(MSP)、直肠最大耐受容量(MTV)、高压区长度(HPZ)肛肠动力学指标;观察患者术后并发症发生情况。结果试验组患者术中出血量明显多于对照组,手术时间及住院时间均明显长于对照组(P﹤0.05)。试验组患者组织治愈性切除率、整块切除率均高于对照组(P﹤0.05)。术后7天,两组患者血清VCAM-1、ICAM-1水平均较术前降低(P﹤0.05)。术后1个月,两组患者RRP、AIRT均较术前升高,ARP、MSP、MTV、HPZ均较术前降低(P﹤0.05);术后1个月,试验组患者RRP、ARP、AIRT均高于对照组,MSP、MTV、HPZ均低于对照组(P﹤0.05);术后6个月,两组患者RRP、AIRT均较术后1个月降低,ARP、MSP、MTV、HPZ均较术后1个月升高(P﹤0.05);术后6个月,两组患者RRP、ARP、AIRT、APWF、MSP、MTV、HPZ比较,差异均无统计学意义(P﹥0.05)。两组患者术后并发症总发生率比较,差异无统计学意义(P﹥0.05)。结论ESD可有效切除ERC及PL病灶,抑制分泌VCAM-1、ICAM-1,对患者肛肠动力学影响小,且疗效较好,若严格选择适应证,术中规范操作,可有效避免术后并发症的发生。

Objective To study the effects of endoscopic submucosal dissection(ESD)and endoscopic mucosal resec-tion(EMR)on vascular cell adhesion molecule-1(VCAM-1)and intercellular adhesion molecule-1(ICAM-1)in patients with early rectal cancer(ERC)and precancerous lesions(PL)and their effects on anorectal kinetics.Method A total of 80 patients with ERC and PL were divided into experimental group(n=40)and control group(n=40)according to the random number table method.The control group received EMR treatment,and the experimental group received ESD treatment.The perioperative indicators and lesion resection in the two groups were observed.The serum VCAM-1 and ICAM-1 levels before surgery and 7 days after surgery were also measured.Before surgery,1 month after surgery,and 6 months after surgery,rectal resting pressure(RRP),anal resting pressure(ARP),anorectal inhibitory reflex threshold(AIRT),anal peristaltic wave frequency(APWF),maximum squeeze pressure(MSP),maximum tolerable volume(MTV),high pressure zone(HPZ)and other anorectal kinetics indicators were recorded.The postoperative complications of patients were also observed and compared.Result The blood loss volume during the operation of the experimental group was significantly more than that of the control group,and the operation time and hospital stay were significantly longer than those of the control group(P<0.05).The rate of curative resection and en-bloc resection of patients in the ex-perimental group were higher than those in the control group(P<0.05).At 7 days after the operation,the levels of serum VCAM-1 and ICAM-1 of the two groups were lower than themselves before operation(P<0.05).One month after the op-eration,RRP and AIRT of the two groups of patients were higher than before the operation,and ARP,MSP,MTV,and HPZ were all lower than before operation(P<0.05).One month after the operation,RRP,ARP,AIRT of patients in the ex-perimental group were higher than the control group,MSP,MTV,HPZ were lower than the control group(P<0.05).Six months after surgery,RRP,AIRT of the two groups were lower than 1 month after surgery,ARP,MSP,MTV,HPZ were higher than 1 month after operation(P<0.05).Six months after the operation,there were no significant differences in RRP,ARP,AIRT,APWF,MSP,MTV,HPZ between the two groups of patients(P>0.05).There was no statistically sig-nificant difference in the total incidence of postoperative complications between the two groups of patients(P>0.05).Conclusion ESD could effectively remove ERC and PL lesions,inhibit the secretion of VCAM-1 and ICAM-1 with lit-tle effect on the patient’s anorectal kinetics,which indicates a good curative effect.If the indications are strictly selected and the operation is standardized,such a regimen can effectively reduce the risk of postoperative complications.