内镜黏膜下剥离术在早期结直肠癌及癌前病变治疗中的效果观察

Effects of endoscopic submucosal dissection in the treatment of early colorectal cancer and precancerous lesions

目的探讨内镜黏膜下剥离术在早期结直肠癌及癌前病变治疗中的效果。方法选取2018年3月—2020年3月河南省某医院收治的138例早期结直肠癌及癌前病变患者为研究对象。采用随机数字表法将患者分为研究组(n=69例)与对照组(n=69例)。对照组患者接受内镜下黏膜切除术治疗,研究组患者接受内镜下黏膜剥离术治疗。比较2组患者手术时间(进入至离开手术室的时间)、术中失血量(称重法和容量法计算失血量)、卧床时间(离开手术室至首次自主下床活动的时间)及住院时间(办理入院至办理出院的时间)。比较2组患者术前、术后3 d时胃动素(MTL)、生长抑素(SS)及D-乳酸(D-LA)水平。比较2组患者在术后3个月随访期内并发症发生情况。结果研究组患者卧床时间及住院时间均短于对照组,差异有统计学意义(P<0.05),研究组患者术中失血量少于对照组,差异有统计学意义(P<0.05)。术前2组患者MTL、SS、D-LA水平比较,差异无统计学意义(P>0.05)。术后3 d时,2组患者MTL、SS水平均低于术前,而研究组MTL水平高于对照组,差异均有统计学意义(P<0.05);2组患者D-LA水平高于术前,而研究组低于对照组,差异有统计学意义(P<0.05)。研究组患者并发症发生率为2.9%,低于对照组的14.5%,差异有统计学意义(P<0.05)。结论内镜黏膜下剥离术治疗早期结直肠癌及癌前病变的疗效确切,可缩短患者术后身体康复时间,减轻手术导致的患者胃肠道功能损伤,降低术后并发症发生率,具有临床推广应用价值。

Objective To explore the effect of endoscopic submucosal dissection in the treatment of early colorectal cancer and precancerous lesions.Methods One hundred and thirty-eight patients with early colorectal cancer and precancerous lesions admitted to a hospital in Henan Province from March 2018 to March 2020 were selected for the study.The patients were divided into a study group(n=69)and a control group(n=69)using the random number table method.Patients in the control group were treated with endoscopic mucosal resection,while patients in the study group were treated with endoscopic mucosal dissection.The operation time(time from entering to leaving the operating room),intraoperative blood loss(blood loss calculated by weighing method and volume method),bed rest time(time from leaving the operating room to the first independent ambulation)and hospitalization time(time from checking in to checking out)were compared between the 2 groups.The levels of motilin(MTL),somatostatin(SS)and D-lactic acid(D-LA)of the 2 groups of patients were compared before surgery and at 3 days after surgery.Complications during the 3-month postoperative follow-up period were compared between the 2 groups.Results The bed rest and hospitalization was shorter in the study group than in the control group,with statistically significant differences(P<0.05),and the amount of intraoperative blood loss was less in the study group than in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in MTL,SS,and D-LA levels between the 2 groups of patients before surgery(P>0.05).At 3 days after surgery,the MTL and SS levels were lower than those before surgery in both groups,but higher about the MTL level in the study group than in the control group.The differences were statistically significant(P<0.05).The D-LA levels were higher than those before surgery in both groups,but lower in the study group than in the control group,and the differences were statistically significant(P<0.05).The complication rate of patients in the study group was 2.9%,which was lower than that in the control group,which was 14.5%,and the difference was statistically significant(P<0.05).Conclusion The effects of endoscopic submucosal dissection in the treatment of early colorectal cancer and precancerous lesions are obvious.It can shorten the physical recovery time of patients after surgery,reduce the functional damage of patients′gastrointestinal tract caused by surgery,and decrease the incidence of postoperative complications,and has clinical promotion value.