内镜下黏膜剥离术与黏膜切除术治疗早期结直肠癌的临床疗效及安全性

Clinical efficacy and safety of endoscopic submucosal dissection and endoscopic mucosal resection in the treatment of early colorectal cancer

目的探究内镜下黏膜剥离术与内镜下黏膜切除术治疗早期结直肠癌的临床疗效及安全性。方法选取2019年1月至2020年12月于本院治疗的68例早期结直肠癌患者作为研究对象,按照治疗方式不同分为对照组与研究组,每组34例。对照组行内镜下内膜切除术治疗,研究组行内镜下黏膜下剥离术治疗,比较两组治疗前后氧化应激反应、炎症反应、手术时间、病灶整块切除率、组织治愈性切除率、并发症发生情况及1年内疾病复发情况。结果治疗前,两组皮质醇(Cor)、促肾上腺皮质激素(ACTH)、超敏C反应蛋白(hs-CRP)和肿瘤坏死因素-α(TNF-α)水平比较差异无统计学意义;治疗后,两组Cor、ACTH、hs-CRP和TNF-α水平均高于治疗前,但研究组低于对照组,差异有统计学意义(P<0.05)。病变直径<2 cm时,研究组病灶整块切除率、组织治愈性切除率均高于对照组,差异有统计学意义(P<0.05)。病变直径≥2 cm时,两组组织治愈性切除率比较差异无统计学意义;研究组病灶整块切除率高于对照组,差异有统计学意义(P<0.05)。两组并发症发生率、1年内疾病复发率比较差异均无统计学意义。结论内镜下黏膜下剥离术治疗早期结直肠癌,手术时间长,但能提高病灶切除率,保证治疗效果,且能降低Cor及ACTH及炎症因子水平,提高病灶整块切除和组织治愈性切除率,未提高并发症及1年内疾病复发率,值得临床推广应用。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection and endoscopic mucosal resection in the treatment of early colorectal cancer.Methods A total of 68 patients with early colorectal cancer treated in our hospital from January 2019 to December 2020 were selected as the research subjects,and they were divided into the control group and the study group according to different treatment methods,with 34 cases in each group.The control group was treated with endoscopic mucosal resection,and the study group was treated with endoscopic submucosal dissection,the oxidative stress response,inflammatory response before and after treatment,operation time,lesion resection rate,tissue healing resection rate,complications and disease recurrence within 1 year were compared between the two groups.Results Before treatment,there were no significant differences in the levels of cortisol(Cor),adrenocorticotropin hormone(ACTH),hypersensitive-C reactive protein(hsCRP)and tumor necrosis factor-α(TNF-α)between the two groups;after treatment,the levels of Cor,ACTH,hs-CRP and TNF-αof the two groups were higher than before treatment,but the study group was lower than the control group,the differences were statistically significant(P<0.05).When the lesion diameter was less than 2 cm,the whole lesion resection rate and curative rate in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).When the lesion diameter was≥2 cm,there was no significant difference in the curative rate between the two groups;the whole lesion resection rate in the study group was higher than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the incidence of complications and the recurrence rate within 1 year between the two groups.Conclusion Endoscopic submucosal dissection in the treatment of early colorectal cancer has long operation time,but it can improve the lesion resection rate and ensure the therapeutic effect,this operation can reduce the levels of Cor,ACTH and inflammatory factors,improve the whole lesion resection and tissue curative resection rate,and does not increase the complication and disease recurrence rate within 1 year,which is worthy of clinical promotion and application.