两种内镜黏膜下剥离术治疗直径≥20 mm结肠肿瘤的效果和经济效益比较

Efficacy and cost-effective comparisons between two types of endoscopic submucosal dissection in the treatment of colonic neoplasm with a diameter≥20 mm

目的比较混合内镜黏膜下剥离术(H-ESD)与传统内镜黏膜下剥离术(C-ESD)治疗直径≥20 mm的结肠肿瘤的效果和经济效益。方法回顾性分析2011年1月至2019年12月在浙江大学医学院附属第一医院接受H-ESD(71例)与C-ESD(85例)治疗的直径≥20 mm的结肠肿瘤患者的临床资料,比较两组患者的一般资料、临床病理特征、疗效、并发症、复发情况和经济效益。结果H-ESD患者与C-ESD患者性别、年龄、肿瘤部位、术前活检病理类型、术前诊断、术后活检病理类型、肿瘤起源层次、随访检查方法等比较差异均无统计学意义(均P>0.05)。H-ESD患者结肠肿瘤的最长径、表面积均小于CESD患者(均P<0.05)。H-ESD患者与C-ESD患者疗效、并发症及复发情况比较差异均无统计学差异(均P>0.05)。H-ESD患者与C-ESD患者手术时间、手术相关设备成本、住院时间比较差异均无统计学意义(均P>0.05)。H-ESD患者总成本低于C-ESD患者(P<0.05),即H-ESD比C-ESD经济效益更好。结论H-ESD与C-ESD在治疗直径≥20 mm的结肠肿瘤方面具有相似的安全性及有效性,但前者经济效益更好,值得在临床上推广。

Objective To compare the efficacy and cost-effectiveness of hybrid endoscopic submucosal dissection(H-ESD)with conventional endoscopic submucosal dissection(C-ESD)for treating colonic neoplasms with a diameter≥20 mm.Methods A retrospective analysis was conducted on the clinical data of patients with colonic neoplasm≥20 mm in diameter who underwent H-ESD(71 cases)and C-ESD(85 cases),respectively,at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2011 to December 2019.The general information and clinicopathological characteristics,as well as the curative effect,complications,recurrence,and cost-effectiveness,were compared between the two groups.Results There were no significant differences in gender,age,tumor location,preoperative biopsy pathological type,preoperative diagnosis,postoperative biopsy pathological type,tumor origin level,and follow-up examination methods between H-ESD and C-ESD groups(all P>0.05).The maximum diameter and surface area of colonic tumors in H-ESD group were smaller than those of C-ESD group(both P<0.05).There were no statistically significant differences in the curative effect,complications,and recurrence,as well as operation time,surgical equipment costs,and hospital stay between H-ESD and C-ESD groups(all P>0.05).However,the total cost of H-ESD group was lower than that of C-ESD group(P<0.05),indicating that H-ESD is more cost-effective than C-ESD.Conclusion H-ESD and C-ESD are similar in safety and effectiveness while treating colonic tumors with a diameter ≥20 mm. However, compared to C-ESD, H ESD is more cost-effective with a lower total cost, thus deserving clinical promotion.