内镜下不同处理策略在结直肠癌前病变和早癌中临床疗效

Clinical Efficacy of Different Treatment Strategies Under Endoscopy in Colorectal Precancerous Lesions and Early-Cancer

目的比较内镜下黏膜切除术(EMR)、内镜下黏膜剥离术(ESD)治疗结直肠癌前病变和早癌的临床疗效。方法收集2018年9月至2020年9月我院122例结直肠癌前病变和早癌患者临床资料进行回顾性分析,根据手术方案分为EMR切除组(n=61)和ESD剥离组(n=61)。对比两组手术效果、手术时间、术前、术后3 d、术后7 d血清白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、降钙素原(PCT)、丙二醛(MDA)、氧化型谷胱甘肽(GSSG)、皮质醇(Cor)水平,术前、术后3个月肿瘤标志物miR21、癌胚抗原(CEA)、糖类抗原724(CA724)水平及并发症情况,及术后3个月复发情况。结果 (1)切除组手术时间短于剥离组(P<0.05),两组完全切除率、整块切除率比较,差异无统计学意义(P>0.05);(2)术后3 d切除组血清IL-6、PCT、TNF-α水平及MDA、GSSG、Cor水平均低于剥离组,差异有统计学意义(P<0.05);(3)与术前比较,术后3个月两组血清miR21、CEA、CA724水平均降低,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);(4)切除组并发症发生率为11.48%(7/61),低于剥离组1.64%(1/61),差异有统计学意义(P<0.05);(5)两组术后3个月复发率差异无统计学意义(P>0.05)。结论 EMR、ESD治疗结直肠癌前病变和早癌效果相当,前者可缩短手术时间,后者可减轻手术创伤应激反应、降低并发症。

Objective To compare the effects of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)to treat colorectal precancerous lesions and early cancer. Methods From September 2018 to September 2020, 122 patients with colorectal precancerous lesions and early cancer in our hospital were collected for retrospective analysis. According to surgical plan, they were divided into resection group(n=61)and dissection group(n=61). EMR and ESD were performed respectively. Surgical effect, operation time, interleukin-6(IL-6), tumor necrosis factor(TNF-α), procalcitonin(PCT), malondialdehyde(MDA), oxidized glutathione(GSSG), cortisol(Cor), miR21, carcinoembryonic antigen(CEA), carbohydrate antigen 724(CA724), complications and recurrence were compared.Results Operation time of resection group was shorter than that of stripping group(P<0.05). There was no significant difference in total resection rate and en bloc resection rate between two groups(P>0.05). IL-6, PCT, TNF-α and MDA, GSSG, and Cor in resection group were lower than those in stripping group at 3 days after surgery(P<0.05). Compared with preoperatively, miR21, CEA, and CA724 decreased in two groups at the first month(P<0.05), but difference between groups was not statistically significant(P>0.05). Incidence of complications in resection group was 11.48%(7/61), which was lower than 1.64%(1/61)(P<0.05)of stripping group. There was no significant difference in recurrence rate between two groups at 3 months after surgery(P>0.05).Conclusion EMR and ESD would be effective in treating colorectal precancerous lesions and early cancer. The former could shorten operation time, and the latter could reduce stress response to surgical trauma and complications.