内镜下分片粘膜切除术与粘膜剥离术治疗结直肠侧向发育型肿瘤疗效及安全性比较

Comparison of the Efficacy and Safety of Endoscopic Segmental Mucosal Resection and Mucosal Dissection in the Treatment of Laterally Developing Colorectal Tumors

目的对比分析内镜下分片粘膜切除术(EPMR)与粘膜剥离术(ESD)治疗结直肠侧向发育型肿瘤疗效及安全性。方法选择2017年3月—2018年11月该院收治的52例结直肠侧向发育型肿瘤患者为研究对象,根据手术方案不同进行分组,将采用内镜下分片粘膜切除术(EPMR)治疗的26例患者设为EPMR组,另将26例行内镜粘膜剥离术治疗的患者设为ESD组,比较两组手术治疗效果及术后并发症、复发情况。结果 EPMR组手术操作平均时间(39.30±4.11)min,较ESD组的(64.23±9.25)min明显缩短(t=12.554,P=0.000)。ESD组的整块切除率、完整切除率以及治愈性切除率均显著高于EPMR组(P<0.05)。ESD组术后并发症发生率7.69%,与EPMR组的3.85%对比,差异无统计学意义(χ~2=0.354,P=0.552)。随访1年,ESD组疾病复发率3.85%,较EPMR组的23.08%明显降低(χ~2=4.127,P=0.042)。结论与内镜下分片粘膜切除术相比,内镜下粘膜剥离术治疗结直肠侧向发育型肿瘤效果更好,病灶整块切除率高,可有效减少疾病复发,且其安全性良好,但该术式手术操作较为复杂,故需由内镜治疗经验丰富的医疗团队操作,并需做好围手术期护理工作,保证手术顺利进行。

Objective To compare and analyze the efficacy and safety of endoscopic lamellar mucosal resection(EPMR)and mucosal dissection(ESD)in the treatment of colorectal lateral developmental tumors.Methods A total of 52 patients with laterally developing colorectal tumors admitted to the hospital from March 2017 to November 2018 were selected as the research object.They were grouped according to different surgical protocols and will be treated by endoscopic segmental mucosal resection(EPMR)Of 26 patients were set as EPMR group,and another 26 patients treated with endoscopic mucosal dissection were set as ESD group,and the surgical treatment effect,postoperative complications and recurrence were compared between the two groups.Results The average operation time of EPMR group was(39.30±4.11)min,which was significantly shorter than that of ESD group(64.23±9.25)min(t=12.554,P=0.000).The resection rate,complete resection rate,and curative resection rate in the ESD group were significantly higher than those in the EPMR group(P<0.05).The incidence of postoperative complications in the ESD group was7.69%,compared with 3.85%in the EPMR group,and there was no statistically significant difference(χ~2=0.354,P=0.552).After 1 year of follow-up,the disease recurrence rate in the ESD group was 3.85%,which was significantly lower than 23.08%in the EPMR group(χ~2=4.127,P=0.042).Conclusion Compared with endoscopic segmental mucosal resection,endoscopic mucosal dissection is more effective in treating colorectal lateral developmental tumors,and the rate of resection of the lesion is high.However,the operation of this type of surgery is relatively complicated,so it needs to be operated by a medical team with rich experience in endoscopic treatment,and perioperative nursing work needs to be done to ensure the smooth operation of the operation.