超级微创手术治疗结直肠早癌与癌前病变的疗效评估

Therapeutic efficacy assessment of super minimally invasive surgery in the treatment of early colorectal cancer and precancerous lesions

目的探讨消化内镜超级微创手术(SMIS)在结直肠早癌与癌前病变患者中的临床疗效。方法回顾性分析2023年1—10月就诊于解放军总医院第一医学中心及第二医学中心行消化内镜SMIS的结直肠早癌与癌前病变357例患者,其中内镜下黏膜切除术(EMR)组168例,内镜下黏膜下层剥离术(ESD)组103例,内镜下高频电切术(EHE)组86例。比较三组患者的息肉情况、术中操作情况、治疗疗效以及经济学评价。结果三组患者性别构成、年龄比较差异无统计学意义(P>0.05)。三组在息肉个数和早期癌变侵犯深度方面比较差异无统计学意义(P>0.05),而三组在息肉形态、大小分布及病理诊断方面比较差异有统计学意义(P<0.001)。三组术中穿孔情况比较差异无统计学意义(P>0.05),但ESD组术中出血率及术后并发症发生率大于EMR组及EHE组[62.1%(64/103)比14.9%(25/168)和7.0%(6/86)、17.5%(18/103)比4.8%(8/168)和7.0%(6/86)](P<0.05)。ESD组非治愈性切除率高于EMR组及EHE组[6.8%(7/103)比0.6%(1/168)、1.2%(1/86)](χ^(2)=8.82,P<0.05),三组整块切除率比较差异无统计学意义(P>0.05)。ESD组住院时长及手术费用高于EMR组及EHE组,差异有统计学意义(P<0.001)。结论不同术式的SMIS均能实现较高的结直肠早癌与癌前病变的整块切除率与治愈性切除率,但术式选择应依据病变的特点进行确定。

Objective To explore the clinical efficacy of endoscopic super minimally invasive surgery(SMIS)in patients with early colorectal cancer and precancerous lesions.Methods The clinical data of 357 patients with early colorectal cancer and precancerous lesions who underwent endoscopic SMIS at the First Medical Center and the Second Medical Center of Chinese PLA General Hospital from January to October 2023 were A analyzed retrospectively.Among them,168 people underwent endoscopic mucosal resection(EMR),103 people underwent endoscopic submucosal dissection(ESD),and 86 people underwent endoscopic high-frequency electrotomy(EHE).The polyp characteristics,intraoperative conditions,treatment efficacy,and economic evaluation were compared among the three groups of patients.Results There were no statistically differences in gender and age among the three patient groups(P>0.05).However,there were statistically differences in the morphology,size,location,and pathological diagnosis of the polyps(P<0.001),while there were no statistically differences in the number of polyps and the depth of early cancer invasion(P>0.05).There were no statistically differences in intraoperative perforation among the three groups(P>0.05),but the ESD group had significantly higher rates of intraoperative bleeding and postoperative complications than the EMR and EHE groups:62.1%(64/103)vs.14.9%(25/168),7.0%(6/86);17.5%(18/103)vs.4.8%(8/168),7.0%(6/86),P<0.05.The non-R0 resection rate in the ESD group was significantly higher than that in the other two groups:6.8%(7/103)vs.0.6%(1/168),1.2%(1/86),χ^(2)=8.82,P<0.05,while there were no statistically difference in en-bloc resection rates(P>0.05).The length of hospital stay and surgical costs in the ESD group were significantly higher than those in the other two groups(P<0.001).Conclusions Different types of SMIS all demonstrate high rates of en-bloc resection and R0 resection for early colorectal cancer and precancerous lesions.However,the choice of which surgery should be determined based on the characteristics of the lesion.