黏膜下注射法及透明帽辅助法内镜下黏膜切除术治疗大肠无蒂息肉的效果与安全性

The effect and safety of submucosal injection and transparent cap assisted endoscopic mucosal resection in the treatment of large colorectal sessile polyps

目的探讨内镜下黏膜切除术(EMR)中黏膜下注射法及透明帽辅助法治疗大肠无蒂息肉的效果与安全性。方法102例行EMR治疗的大肠无蒂息肉患者,随机分为对照组和观察组,每组51例。对照组采用传统黏膜下注射法治疗,观察组在对照组基础上采用透明帽辅助法治疗。比较两组一次性切除成功率、手术相关指标与术后并发症发生情况。结果观察组一次性切除成功率为94.12%(48/51),高于对照组的78.43%(40/51),差异有统计学意义(P<0.05)。观察组手术耗时(17.86±1.44)min长于对照组的(12.88±1.70)min,术后恢复饮食时间(18.25±2.73)h、住院时长(7.06±1.00)d均短于对照组的(20.84±2.27)h、(8.10±1.08)d,术中出血量(7.25±1.77)ml少于对照组的(8.02±1.17)ml,差异有统计学意义(P<0.05)。两组局限性腹膜炎发生率比较差异无统计学意义(P>0.05)。观察组术后出血发生率3.92%低于对照组的15.69%,差异有统计学意义(P<0.05)。结论与单独黏膜下注射法相比,联合透明帽辅助EMR(EMR-C)能明显提高大肠无蒂息肉切除效果,降低术后出血风险,改善患者预后,同时缩短住院时长,减轻患者负担,是一种安全有效的大肠无蒂息肉切除术。

Objective To discuss the effect and safety of submucosal injection and transparent cap assisted endoscopic mucosal resection(EMR)in the treatment of large colorectal sessile polyps.Methods A total of 102 patients with large colorectal sessile polyps treated by EMR were randomly divided into control group and observation group,with 51 cases in each group.The control group was treated with traditional submucosal injection,and the observation group was treated with transparent cap assistant method on the basis of control group.The success rate of one-time resection,surgery related indexes and postoperative complications were compared between the two groups.Results The success rate of one-time resection was 94.12%(48/51)in the observation group,which was higher than that of 78.43%(40/51)in the control group,and the difference was statistically significant(P<0.05).The operative time of(17.86±1.44)min in the observation group was longer than that of(12.88±1.70)min in the control group;the postoperative recovery time for diet of(18.25±2.73)h and length of hospital stay of(7.06±1.00)d in the observation group were shorter than those of(20.84±2.27)h and(8.10±1.08)d in the control group;the intraoperative blood loss of(7.25±1.77)ml in the observation group was less than that of(8.02±1.17)ml in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of localized peritonitis between the two groups(P>0.05).The incidence of postoperative bleeding of was 3.92%in the observation group lower than that of 15.69%in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with submucosal injection method alone,transparent cap assisted EMR-C can significantly improve the therapeutic effect of large colorectal sessile polyps,reduce the risk of postoperative bleeding,and improve the prognosis of patients,while shortening the length of hospital stay and reducing patient burden,which is a safe and effective method for resection of large colorectal sessile polyps.