冷圈套器息肉切除术与冷内镜黏膜切除术治疗5~10 mm无蒂结直肠息肉的效果及安全性比较

Comparison of effect and safety of cold snare polypectomy and cold endoscopic mucosal resection in treatment of 5-10 mm non-pedunculated colorectal polyps

目的比较冷圈套器息肉切除术(CSP)与冷内镜黏膜切除术(EMR)治疗5~10 mm无蒂结直肠息肉的效果与安全性。方法本研究为单中心回顾性研究,选取2021年1月至2022年9月在首都医科大学附属北京安贞医院消化内科行结直肠息肉切除的246例患者作为研究对象,共切除368枚息肉,根据息肉切除术式不同分为CSP组(115例,173枚息肉)和冷EMR组(131例,195枚息肉)。比较2组一般资料、息肉完整切除率、息肉切除时间及手术相关不良事件发生情况。结果2组息肉大小、息肉部位、息肉形态、病理分型差异均无统计学意义(均P>0.05)。CSP组与冷EMR组息肉完整切除率差异无统计学意义[92.5%(160/173)比95.9%(187/195)](χ^(2)=1.983,P=0.159)。CSP组息肉切除时间短于冷EMR组[(66±10)s比(107±11)s],差异有统计学意义(t=-37.426,P<0.001)。CSP组与冷EMR组术中即刻出血率差异无统计学意义[6.4%(11/173)比4.1%(8/195)](χ^(2)=0.953,P=0.329),2组均无迟发出血和穿孔发生。结论CSP组和冷EMR组在息肉完整切除率和手术相关不良事件方面没有显著差异,但CSP操作更省时。CSP仍是5~10 mm无蒂结直肠息肉的主要切除方法。

Objective To compare the effect and safety of cold snare polypectomy(CSP)and cold endoscopic mucosal resection(EMR)in treatment of 5-10 mm non-pedunculated colorectal polyps.Methods This study was a single center retrospective study.From January 2021 to September 2022,246 patients who underwent colorectal polypectomy at the Department of Gastroenterology,Beijing Anzhen Hospital,Capital Medical University were selected as the research objects.A total of 368 polyps were removed.The patients were divided into CSP group(115 cases,173 polyps)and cold EMR group(131 cases,195 polyps).The general data,complete polypectomy rate,polypectomy time and surgery-related adverse events were compared between the two groups.Results There was no significant difference in polyp size,polyp location,polyp morphology and pathological classification between the two groups(all P>0.05).There was no significant difference in the complete polypectomy rate between CSP group and cold EMR group[92.5%(160/173)vs 95.9%(187/195)](χ^(2)=1.983,P=0.159).The polypectomy time in CSP group was shorter than that in cold EMR group[(66±10)s vs(107±11)s],and the difference was statistically significant(t=-37.426,P<0.001).There was no significant difference in the immediate intraoperative bleeding rate between CSP group and cold EMR group[6.4%(11/173)vs 4.1%(8/195)](χ^(2)=0.953,P=0.329),and no delayed bleeding and perforation occurred in both groups.Conclusion There is no significant difference between CSP group and cold EMR group in terms of complete polypectomy rate and surgery-related adverse events,but the CSP procedure is more time saving.CSP is still the main method for the resection of 5-10 mm non-pedunculated colorectal polyps.