内镜下黏膜切除术与黏膜下剥离术治疗早期直肠癌的疗效观察

Efficacy of endoscopic mucosal resection versus endoscopic submucosal dissection in patients with early rectal cancer

目的 探讨内镜下黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)对早期直肠癌患者的治疗效果。方法 选取2017年5月至2020年5月间商洛职业技术学院附属医院收治的98例早期直肠癌患者作为研究对象,将应用EMR治疗的56例患者纳入EMR组,将应用ESD治疗的42例患者纳入ESD组。对比两组患者的围术期情况、术后恢复情况、整体切除率、术后远期复发率、术后并发症发生率以及手术前后生活质量。结果 两组患者排便时间、肛门排气时间和肠鸣音恢复时间比较,差异无统计学意义(P>0.05)。EMR组患者的手术时间和治疗费用均低于ESD组,差异均有统计学意义(均P<0.05)。两组整体切除率、1年、2年和3年复发率比较,差异无统计学意义(P>0.05)。两组患者术后穿孔、迟发性出血及感染等并发症发生率比较,差异无统计学意义(P>0.05)。两组患者术前生活质量比较,差异无统计学意义(P>0.05);手术3个月后,两组患者精神健康、情感职能、活力、生理职能、生理功能、总体健康评分均升高,且ESD组高于EMR组,差异均有统计学意义(均P<0.05)。结论 早期直肠癌患者应用EMR与ESD均具有良好的治疗效果,ESD手术相对复杂,时间较长,但能够提升整体切除率,降低远期复发率,提升患者术后生活质量,而手术费用较高,可依照患者意愿酌情选择不同手术进行治疗。

Objective To compare the efficacy of endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) in the treatment of early rectal cancer. Methods Ninety-eight patients with early rectal cancer were selected at Shangluo Vocational and Technical College Affiliated Hospital/Shangluo International Medical Center Hospital from May 2017 to May 2020. Fifty-six patients undergoing endoscopic mucosal resection were included in an EMR group and 42 patients undergoing endoscopic submucosal dissection were included in an ESD group. The perioperative situation, postoperative recovery, overall resection rate, postoperative long-term recurrence rate, incidence of postoperative complications and quality of life before and after operation were compared between the two groups. Results There was no significant difference in time to defecation, time to anal exhaust and time to recovery of bowel sounds between the two groups(P>0.05). Duration of operation and treatment cost were significantly lower in EMR group than in the control group(all P<0.05). There was no significant difference in the overall resection rate, 1-, 2-and 3-year recurrence rate between the two groups(P>0.05). However, the overall resection rate was higher and the long-term recurrence rate was lower in ESD group than in EMR group(all P<0.05). There was no significant difference in the incidence of perforation, delayed bleeding and infection between the two groups(P>0.05). Moreover, there was no significant difference in quality of life between the two groups before operation(P>0.05). At 3 months after the operation, mental health, emotional function, vitality, physiological function, physiological function and overall health scores were increased in the two groups, and the scores were higher in ESD group than in EMR group(all P<0.05). Conclusion Both endoscopic mucosal resection and endoscopic submucosal dissection are effective in the treatment of early rectal cancer. Endoscopic submucosal dissection can improve overall resection rate, reduce long-term recurrence rate, and improve quality of life although the procedure of it is relatively complex, and its duration is relatively long. However, its operation cost is high. Different operations can be selected according to the wishes of patients.