冷圈套息肉切除术对直径≤15mm结肠息肉内镜下切除及减轻机体应激和炎性反应的研究

Endoscopic removal of colonic polyps less than 15 mm in diameter with cold snare polypectomy and the attenuation of stress and inflammation response

目的研究冷圈套息肉切除术对直径≤15 mm结肠息肉内镜下切除及减轻机体应激和炎性反应的作用。方法本研究采用前瞻性研究方法, 以湖北省中医院2019年9月至2022年8月诊断并进行治疗的直径≤15 mm结肠息肉患者120例作为研究对象, 采用随机数字表法将以上患者分为试验组60例以及对照组60例, 试验组患者采取冷圈套息肉切除术进行治疗, 对照组患者采取内镜下黏膜切除术进行治疗。分别对两组患者的手术操作指标、急性时相蛋白水平、应激反应指标以及并发症之间的差异采用χ^(2)检验以及Fisher精确检验进行比较。结果试验组患者手术时间低于对照组[(2.63±0.55) min比(3.82±0.54) min, t=11.959, P<0.05]。术后两组患者的CRP、SAA、AAT均高于术前[(7.10±2.85)、(13.73±2.96) mg/L比(4.97±0.78)、(4.95±0.81) mg/L, (13.25±3.06)、(17.11±2.68) mg/L比(7.07±1.62)、(7.01±1.50) mg/L, (1 893.56±53.39)、(3 427.65±52.47) mg/L比(1 240.61±53.78)、(1 240.61±53.78) mg/L, t=5.584、22.161、13.826、25.473、66.863、225.468, P<0.05], 且试验组患者的CRP、SAA、AAT低于对照组(t=12.630、7.350、158.742, P<0.05)。术后, 两组患者的Cor、NE、ACTH以及ATⅡ高于术前[(126.50±2.48)、(146.91±3.55) ng/ml比(94.98±3.36)、(94.87±3.88) ng/ml, (0.42±0.09)、(0.59±0.26) ng/ml比(0.21±0.14)、(0.24±0.12) ng/ml, (35.58±3.87)、(43.14±3.14) pg/ml比(27.03±3.10)、(27.58±2.56) pg/ml, (42.02±3.59)、(50.33±3.95) ng/ml比(34.81±3.23)、(34.92±3.98) ng/ml, t=58.464、76.650、9.774、9.468、13.356、29.750、11.565、21.287, P<0.05], 且试验组患者的Cor、NE、ACTH以及ATⅡ低于对照组(t=36.508、4.786、11.750、12.059, P<0.05)。结论在对直径≤15 mm结肠息肉患者的治疗中, 采用冷圈套息肉切除术对患者进行手术, 可显著降低炎性反应以及应激反应。

Objective To explore the clinical efficacy of endoscopic removal of colonic polyps less than 15mm in diameter with cold snare polypectomy(CSP),and to test the attenuation effect of stress and in-flammation response.Methods A prospective cohort study was conducted to enroll 120 patients with colonic polyps less than 15mm in diameter underwent treatment in Hubei Provincial Hospital of TCM.Patients were randomly assigned into two groups,each with 60 cases.Experimental group was given CSP,while control group adopted endoscopic mucosal resection.Then the surgical indicators,acute-phase protein levels,and stress response indicators were compared between two groups.Results The operation time of experimental group was shorter than that of control group[(2.63±0.55)min vs.(3.82±0.54)min,t=11.959,P<0.05].Levels of C-reactive protein(CRP),serum amyloid A protein(SAA)and alpha-1-antitrypsin(AAT)of both groups after surgery were higher than those at study entry[(7.10±2.85),(13.73±2.96)mg/L vs.(4.97±0.78),(4.95±0.81)mg/L;(13.25±3.06),(17.11±2.68)mg/L vs.(7.07±1.62),(7.01±1.50)mg/L;(1893.56±53.39),(3427.65±52.47)mg/L vs.(1240.61±53.78),(1240.61±53.78)mg/L,t=5.584,22.161,13.826,25.473,66.863,225.468,all P<0.05].Postoperative CRP,SAA and AAT levels of experimental group were all lower than those in control group(t=12.630,7.350,158.742,P<0.05).Levels of cortisol(Cor),norepinephrine(NE),adrenocorticotropic hormone(ACTH)and angiotensin II receptor subtype 2(AT II)of both groups after surgery were higher than those before surgery[(126.50±2.48),(146.91±3.55)ng/ml vs.(94.98±3.36),(94.87±3.88)ng/ml;(0.42±0.09),(0.59±0.26)ng/ml vs.(0.21±0.14),(0.24±0.12)ng/ml;(35.58±3.87),(43.14±3.14)pg/ml vs.(27.03±3.10),(27.58±2.56)pg/ml;(42.02±3.59),(50.33±3.95)ng/ml vs.(34.81±3.23),(34.92±3.98)ng/ml,t=58.464,76.650,9.774,9.468,13.356,29.750,11.565,21.287,all P<0.05],and the postoperative Cor,NE,ACTH and AT I of experimental group were lower than those of control group(t=36.508,4.786,11.750,12.059,P<0.05).Conclusion Application of CSP in treatment of patients with colonic polyps less than 15 mm in diameter can effectively attenuate the inflammation and stress responses.