传统手术与内镜黏膜下剥离术治疗低位直肠较大腺瘤效价比及价值探讨

Analysis of the efficacy and cost ratio of traditional surgery and endoscopic submucosal dissection in the treatment of low rectal adenoma

目的探讨传统经肛门局部切除术与内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗低位直肠腺瘤效价比。方法 2012年11月~2019年11月期间我院收治的低位直肠较大腺瘤病人96例,按两种手术方法将其分为两组,观察组48例,采用传统经肛门局部切除术;对照组48例,采用内镜黏膜下剥离术(ESD)。比较两组的手术疗效、肛门疼痛情况、住院费用和耗材比。结果两组肿瘤完全切除率、完整切除率、术后并发症发生率、局部复发率比较,差异无统计学差异(P>0.05)。经肛门局部切除组术后第2小时、8小时、12小时肛门疼痛VAS评分均高于ESD组,差异有统计学意义(P<0.05);经肛门局部切除组住院费用和耗材比少于ESD组,差异有统计学意义(P<0.05)。结论在确定低位直肠腺瘤治疗方案时,应根据病人病情、医院医疗技术水平及经济情况等选择最佳术式。

Objective To explore the titer ratio of local resection through anus and endoscopic submucosal dissection(ESD) for the treatment of large adenoma of lower rectum, so as to provide a reference for the rational choice of operation.Methods From November 2012 to November 2019,96 patients with large low rectal adenoma were divided into two groups according to two surgical methods, 48 cases in the observation group were treated with traditional transanal local resection, and 48 cases in the control group were treated with endoscopic submucosal dissection(ESD).The operation efficacy, anal pain, hospitalization expenses and consumables ratio of the two groups were compared.Results There was no significant difference between the two groups in complete resection rate, whole block resection rate, postoperative complication rate and local recurrence rate(P>0.05).The VAS scores of postoperative anal pain at 2 h, 8 h and 12 h in the local anal resection group were higher than those in the ESD group, and the difference was statistically significant(P<0.05);the cost of hospitalization and the ratio of consumables in the local anal resection group were significantly lower than that in the ESD group(P<0.05).Conclusion In the treatment of low rectal adenoma, the best operation should be selected according to the patient’s condition, the level of hospital medical technology and the patient’s economic situation.