冷内镜黏膜切除术与常规内镜黏膜切除术治疗10-19 mm结直肠息肉的对比研究

Safety and efficacy of cold endoscopic mucosal resection vs conventional endoscopic mucosal resection for treatment of 10-19 mm colorectal polyps

背景 结直肠息肉是结直肠癌的重要癌前病变,需及时行内镜下治疗,不同治疗方法对不同大小息肉的疗效和安全性存在差异.本文对不同方法治疗10 mm-19 mm结直肠息肉的的疗效和安全性进行探讨,为临床治疗结直肠息肉提供参考.目的 比较冷内镜黏膜切除术(cold endoscopic mucosal resection,C-EMR)与常规内镜黏膜切除术(endoscopicmucosal resection,EMR)治疗10 mm-19 mm结直肠息肉的疗效和安全性.方法 择取2021-01/2022-12期间在湖州师范学院附属第一医院住院收治的192例10 mm-19 mm结直肠息肉患者,共371枚息肉,分别采用C-EMR治疗(C-EMR组)和常规EMR治疗(EMR组),对两组患者的年龄、性别、肠道准备评分及息肉直径大小、部位、内镜下巴黎分型、病理组织学类型、完整切除率、组织学完全切除率、并发症发生率、切除时间、止血夹使用数量、术后复发等情况进行比较.结果 两组患者的年龄、性别、肠道准备评分及息肉内镜下巴黎分型、病理组织学类型、直径大小、部位比较均无统计学意义.两组息肉的完整切除率、组织学完全切除率比较均无统计学意义.C-EMR组有5.5%(10/181)的息肉和7.4%(7/95)的患者出现术中出血,EMR组有2.6%(5/190)的息肉和3.1%(3/97)的患者出现术中出血,但差异无统计学意义,而C-EMR组有0.6%(1/181)的息肉和1.1%(1/95)的患者出现术后迟发性出血,EMR组有5.8%(11/190)的息肉和7.2%(7/97)的患者出现术后迟发性出血,差异有统计学意义(P<0.05),两组均未见术中和术后迟发性穿孔发生;C-EMR组切除的平均时间(3.15±0.61) min短于EMR组(3.46±0.42)min,差异有统计学意义(P <0.05);C-EMR组止血夹平均使用数量为(1.31±0.88)个少于EMR组(1.65±0.61)个,差异有统计学意义(P <0.05);两组患者共随访息肉164枚,随访时间9 mo-23 mo,切除术后总复发率为2.44%,C-EMR复发率(2.53%)高于EMR组(2.35%),差异无统计学意义.结论 C-EMR与常规EMR在10mm-19mm结直肠息肉的治疗上具有相似疗效,C-EMR治疗时间短,迟发性出血发生率和止血夹使用数量少,安全性和经济效益比更高,值得临床推广应用.

BACKGROUND Colorectal polyps are important precancerous lesions in colorectal cancer,which require timely endoscopic treatment.For different extents of polyps,different therapies have different efficacy and safety.This study explored the efficacy and safety of two different methods for treating 10-19 mm colorectal polyps,with an aim to provide guidance for clinical treatment of colorectal polyps.AIM To compare the safety and efficacy of cold endoscopic mucosal resection(C-EMR) and conventional endoscopic mucosal resection(EMR) in the treatment of 10-19 mm colorectal polyps.METHODS A total of 192 patients with 371 colorectal polyps measuring 10-19 mm,who were hospitalized at the First Affiliated Hospital of Huzhou University from January 2021 to December 2022,were included in this study.The patients underwent either C-EMR or conventional EMR for the colorectal polyps.Age,gender,intestinal preparation score,polyp diameter,location,Paris endoscopic classification,histopathological type,complete resection rate,complete histological resection rate,incidence of complications,resection time,number of hemostatic clips used,and postoperative recurrence were compared between the two groups of patients.RESULTS There was no significant difference in age,sex,intestinal preparation score,Paris endoscopic classification,histopathological classification,size,location,complete resection rate,or complete histological resection rate between the two groups(P 0.05).Immediate intraoperative bleeding occurred in 5.5%(10/181) of polyps and 7.4%(7/95) of patients in the C-EMR group,and the corres-ponding percentages in the EMR group were 2.6%(5/190) and 3.1%(3/97);the difference was not statistically significant between the two groups(P 0.05).Postoperative delayed bleeding occurred in 0.6%(1/181) of polyps and 1.1%(1/95) of patients in the C-EMR group,and the corresponding percentages in the EMR group were 5.8%(11/190) and 7.2%(7/97);the difference was statistically significant between the two groups(P 0.05).There was no occurrence of delayed perforation during or after surgery in either group.The average resection time was significantly shorter in the C-EMR group than that of the conventional EMR group [(3.15 ± 0.61) min vs(3.46 ± 0.42) min,P 0.05].The average number of hemostatic clips used in the C-EMR group was(1.31 ± 0.88),which was significantly less than that of the conventional EMR group(1.65 ± 0.61;P 0.05).A total of 164 polyps were followed for 9 to 23 mo in the two groups of patients.The total recurrence rate after resection was 2.44%,and the recurrence rate of C-EMR(2.53%) was higher than that of the conventional EMR group(2.35%),but with no statistical significance(P 0.05).CONCLUSION C-EMR and conventional EMR have similar therapeutic effects in the treatment of 10-19 mm colorectal polyps,but C-EMR has a shorter treatment time,lower incidence of delayed bleeding,and higher safety and economic benefit ratio.