预切开内镜下黏膜切除术与内镜黏膜下剥离术在结直肠侧向发育型肿瘤患者中应用对比

Comparison of Pre-cut Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in Patients with Colorectal Laterally Spreading Tumor

目的:探讨预切开内镜下黏膜切除术(Pre-cut-EMR)与内镜黏膜下剥离术(ESD)在结直肠侧向发育型肿瘤(LST)中的应用效果。方法:选取2021年1月—2022年12月甘肃省人民医院收治的94例结直肠LST患者,按随机数字表法将其分为两组,各47例。对照组予以ESD治疗,观察组予以Pre-cut-EMR治疗。比较两组手术情况、应激指标、生活质量及并发症。结果:观察组手术时间、术后排气时间、术后排便时间均短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05)。术后24 h,观察组促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、皮质醇(Cor)、C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(P<0.05)。术后3个月,观察组世界卫生组织生存质量测定简表(WHOQOL-BREF)中生理、心理、社会及环境维度评分均高于对照组,差异均有统计学意义(P<0.05)。两组并发症发生率对比,差异无统计学意义(P>0.05)。结论:Pre-cut-EMR在结直肠LST治疗中效果更佳,能够缩短手术时间,减轻应激反应,安全可靠。

Objective:To explore the application effect of pre-cut endoscopic mucosal resection(Pre-cut-EMR)and endoscopic submucosal dissection(ESD)in colorectal laterally spreading tumor(LST).Method:A total of 94 patients with colorectal LST admitted to Gansu Provincial Hospital from January 2021 to December 2022 were selected and divided into two groups according to random number table method,with 47 cases in each group.The control group was treated with ESD,and the observation group was treated with Pre-cut-EMR.The operation situation,stress indexes,quality of life and complications were compared between the two groups.Result:The operation time,postoperative exhaust time and postoperative defecation time in the observation group were shorter than those in the control group,and intraoperative bleeding volume was less than that in the control group,the differences were statistically significant(P<0.05).24 h after operation,the levels of adrenocorticotropic hormone(ACTH),norepinephrine(NE),cortisol(Cor)and C reactive protein(CRP)in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Three months after operation,the scores of physical,psychological,social and environmental dimensions of the World Health Organization quality of life brief scale(WHOQOL-BREF)in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Pre-cut-EMR is more effective in colorectal LST,can shorten the operation time,reduce stress reaction,and is safe and reliable.