环周状预切开后内镜下黏膜切除术法治疗结肠广基息肉的临床效果

Clinical effects of endoscopic mucosal resection in the treatment of colorectal polyps after circumferential precut

目的 比较环周状预切开后内镜下黏膜切除术（EMR-P）法与普通黏膜下注射后内镜下黏膜切除术（EMR）法治疗2 cm左右结肠广基息肉法的临床效果。方法 于2013年1月-2015年12月间对本中心结肠镜检查发现的55例符合纳入标准的结肠广基息肉患者按随机数字表法分为观察组27例和对照组28例;观察组采用环周状预切开后内镜下黏膜切除术法治疗,对照组采用普通黏膜下注射后内镜下黏膜切除术法治疗。比较两组病灶一次性切除率、圈套器使用次数、残留灶处理率、术中出血率、术后出血率、手术时间及切除后创面使用金属夹封闭组和创面暴露组术后出血率。结果 观察组一次性切除率、圈套器使用次数、残留灶处理率优于对照组,术中出血率、术后出血率、手术时间无明显差异。术后创面不同处理方法术后出血率无明显差异（P〉0.05）。结论EMR-P法治疗2 cm左右的结肠广基息肉具有一次性切除率高、切除标本完整、残留灶率低的优点。

Objective To study the advantages of endoscopic mucosal resection（EMR-P） after circumferential precut in the treatment of colorectal polyps with the size of 2 cm compared with the regular endoscopic mucosal resection（EMR）.Methods A total of 55 patients with colorectal polyps conforming to the standard who were examined by the endoscopy in our center from January 2013 to December 2015 were assigned into observation group（27 patients） and control group（28 patients） according to the method of random number table. The observation group was treated by endoscopic mucosal resection after circumferential precut, and the control group was treated by endoscopic mucosal resection after regular submucosal injection. The rate of one-time resection of the lesion, the frequency of snare use, the management rate of residual stoma, the rate of bleeding during surgery, the rate of bleeding after surgery, the time of operation were compared between the two groups, and the postoperative bleeding rate between the group of metal clip closure on the wound surface after resection and the group of wound surface exposure. Results The one-time resection rate, the frequency of snare use and the management rate of residual stoma in the observation group were superior to those in the control group. The bleeding rate during surgery, bleeding rate after surgery and operation time were not significantly abnormal.There was no significant difference in postoperative bleeding rate between different treatment method of wound surface（P〈0.05）. Conclusion EMR-P has a high rate of one-time resection, complete resection, and low residual rate in the treatment of colorectal polyps with the size of about 2 cm.