内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的临床分析

Endoscopic submucosal dissection in the treatment of laterally spreading tumors of large intestine

目的研究并探讨内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的临床效果。方法选取我院2015年1月~2017年1月收治的50例大肠侧向发育型肿瘤患者作为研究对象,按照计算机随机数字分组法,将患者分为两组,每组各25例。对照组实施内镜下黏膜切除术,观察组实施内镜黏膜下剥离术,比较两组患者的手术时间、术中出血量、整块切除率、完整切除率、转外科手术概率、并发症发生率、复发率。结果观察组患者的手术时间长于对照组,差异有统计学意义(P<0.05);观察组的术中出血量与对照组比较,差异无统计学意义(P>0.05)。观察组的整块切除率、完整切除率均高于对照组,差异有统计学意义(P<0.05)。在内镜治疗时,观察组转外科手术的概率为8%,对照组为4%,两组比较,差异无统计学意义(P>0.05)。手术后,观察组的并发症总发生率为12%,对照组为4%,两组比较,差异无统计学意义(P>0.05)。术后随访3~12个月,观察组的肿瘤局部复发率为4%,低于对照组的24%,差异有统计学意义(P<0.05)。结论内镜黏膜下剥离术治疗大肠侧向发育型肿瘤具有显著的效果,不仅有较高的整块切除率、完整切除率,还可有效减少术后肿瘤局部的复发。

Objective To study and explore the clinical effect of endoscopic submucosal dissection in the treatment of laterally spreading tumor of large intestine.Methods From January 2015 to January 2017,50 patients with laterally spreading tumor of the large intestine treated in our hospital were selected as the subjects,according to the computer random grouping method,the patients were divided into two groups,25 cases in each group.The control group received endoscopic mucosal resection,the observation group received endoscopic submucosal dissection.The operation time,intraoperative bleeding,en bloc resection rate,complete resection rate surgical operation,probability,complication rate,recurrence rate were compared between the two groups.Results The operation time in the observation group was longer than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the amount of bleeding between the observation group and the control group(P>0.05).The overall resection rate and complete resection rate of the observation group were higher than those of the control group,the differences were statistically significant(P<0.05).In the endoscopic treatment,the probability of surgery in the observation group was 8%,and the control group was 4%,there was no significant difference between the two groups(P>0.05).After operation,the total incidence of complications in the observation group was 12%,and the control group was 4%,there was no significant difference between the two groups(P>0.05).After a follow-up of 3 to 12 months,the local recurrence rate of the observation group was 4%,which was lower than that of the control group(24%)(P<0.05).Conclusion Endoscopic submucosal dissection has a significant effect in the treatment of laterally spreading tumors of the colon,which not only has high en bloc resection rate,complete resection rate,but also can effectively reduce the local recurrence of tumor.