非注射黏膜切除术治疗长径小于2 cm巴黎分型0-Ⅰ型结肠息肉的回顾性临床研究

A retrospective clinical study of non-injection mucosal resection for Paris type 0-Ⅰ colonic polyps less than 2 cm

目的探讨非注射黏膜切除术治疗长径<2 cm且巴黎分型0-Ⅰ型结肠息肉的临床价值。方法采集2019年1月—2019年12月在南京大学医学院附属鼓楼医院消化科采用非注射黏膜切除术治疗长径<2 cm且巴黎分型0-Ⅰ型结肠息肉患者资料,即非注射组;采集同期以常规内镜黏膜切除术(endoscopic mucosal resection,EMR)治疗者作为对照,即EMR组。对两组的完整切除率、手术时间、并发症发生率、术后1年息肉检出率等方面进行比较。结果研究共采集非注射组患者373例,EMR组患者743例。非注射组和EMR组患者在性别[男性占比68.6%(256/373)比64.6%(480/743),χ^(2)=1.796]、年龄[(56.2±11.8)岁比(57.4±11.2)岁,t=-1.984]、息肉数[(1.5±0.9)枚比(1.4±0.8)枚,t=1.776]、息肉分布[右半结肠占比48.0%(269/561)比34.6%(362/1045),χ^(2)=3.364]、病灶大小[长径<1 cm者占比80.0%(449/561)比76.9%(804/1045),χ^(2)=2.043]等方面差异均无统计学意义(P>0.05)。非注射组患者手术时间为(2.82±1.70)min,短于EMR组的(4.94±2.54)min,差异有统计学意义(t=-16.489,P<0.001)。非注射组患者金属夹使用个数为(0.90±0.68)个,少于EMR组的(1.30±0.73)个,差异有统计学意义(t=-8.971,P<0.001)。非注射组和EMR组病灶整块切除率均为100.0%。非注射组完整切除率[97.3%(546/561)]与EMR组[98.1%(1025/1045)]比较,差异无统计学意义(χ^(2)=0.749,P=0.387)。非注射组迟发性出血发生率和EMR组相比差异无统计学意义[0.0%(0/373)比0.8%(6/743),P=0.187]。两组患者均未出现术中穿孔及迟发性穿孔。两组间电凝综合征发生率差异无统计学意义[0.8%(3/373)比0.7%(5/743),P=0.534]。非注射组有63例患者在设定期限内进行了肠镜复查,息肉检出率41.2%(26/63),EMR组有178例患者复查,息肉检查率为53.9%(96/178),两组间差异无统计学意义(χ^(2)=2.985,P>0.05)。结论对于长径<2 cm且巴黎分型0-Ⅰ型结肠息肉,采用非注射黏膜切除术治疗安全、有效,能够显著缩短手术时间,值得临床推广应用。

Objective To evaluate the value of non-injection mucosal resection for Paris type 0-Ⅰcolon polyps with a long diameter less than 2 cm.Methods At the Department of Gastroenterology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,patients with type 0-Ⅰcolonic polyps of a long diameter less than 2 cm who underwent non-submucosal injection resection from January 2019 to December 2019 were enrolled as the non-injection group,and those who received endoscopic mucosal resection(EMR)in the same period were enrolled as the control(EMR group).The differences in complete resection rate,operation time,complication incidence and 1-year follow-up polyp detection rate between the two groups were compared.Results A total of 373 patients were treated with non-injection mucosal resection and 743 patients with conventional EMR.There was no significant difference in gender[68.6%(256/373)VS 64.6%(480/743)for male,χ^(2)=1.796],age(56.2±11.8 years VS 57.4±11.2 years,t=-1.984),number of polyps(1.5±0.9 VS 1.4±0.8,t=1.776),polyp distribution[48.0%(269/561)VS 34.6%(362/1045)in right colon,χ^(2)=3.364],lesion diameter less than 1 cm[80.0%(449/561)VS 76.9%(804/1045),χ^(2)=2.043]between the two groups(P>0.05).The operation time in the non-injection group was 2.82±1.70 min,which was shorter than that in the EMR group(4.94±2.54 min)with significant difference(t=-16.489,P<0.001).The number of metal clips used in the non-injection group was 0.90±0.68,which was less than that in the EMR group(1.30±0.73,t=-8.971,P<0.001).The en bloc resection rates of lesions in non-injection group and EMR group were both 100.0%.The complete resection rate of non-injection group was 97.3%(546/561),which was not significantly different from that of EMR group[98.1%(1025/1045),χ^(2)=0.749,P=0.387].There was no significant difference in the incidences of delayed bleeding in the two groups[0.0%(0/373)VS 0.8%(6/743),P=0.187].No intraoperative or delayed perforation in either group occurred.There was no significant difference in the incidence of electrocoagulation syndrome between the two groups[0.8%(3/373)VS 0.7%(5/743),P=0.534].A total of 63 patients in the non-injection group underwent colonoscopy review within the set period,and the polyp detection rate was 41.2%(26/63).A total of 178 patients in the EMR group also underwent colonoscopy review,and the polyp detection rate was 53.9%(96/178).There was no significant difference in the polyp detection rate between the two groups(χ^(2)=2.985,P>0.05).Conclusion Non-submucosal injection resection is safe and effective for Paris type 0-Ⅰcolon polyps with a long diameter less than 2 cm,which can significantly shorten the operation time and is worth of clinical promotion.