内镜下不同术式治疗胃息肉的临床疗效与安全性评价

Evaluation of clinical efficacy and safety of different endoscopic procedures in the treatment of gastric polyps

目的评价内镜下不同术式治疗胃息肉的临床疗效及安全性。方法92例胃息肉患者,依据术式不同分为黏膜切除组(50例)和高频电切组(42例)。高频电切组行高频电凝切除术治疗,黏膜切除组行内镜下黏膜切除术(EMR)治疗。对比两组患者围术期指标(手术时间、术中出血量、术后开始进流食时间、住院时间)、临床疗效、炎性因子[白细胞介素6(IL-6)、C反应蛋白(CRP)]水平、血清因子[胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)]水平、并发症(黏膜肌层损伤、出血、腹痛)发生情况。结果黏膜切除组手术时间(12.40±5.00)min、术后开始进流食时间(1.65±0.31)d、住院时间(6.13±2.00)d均短于高频电切组的(14.58±4.10)min、(2.09±0.41)d、(7.26±1.45)d,术中出血量(7.10±2.00)ml少于高频电切组的(12.36±3.15)ml(P<0.05)。黏膜切除组总有效率88.00%高于高频电切组的71.43%(P<0.05)。术后3 d,黏膜切除组IL-6(178.96±13.05)pg/ml、CRP(52.78±6.91)mg/L均低于高频电切组的(235.22±16.78)pg/ml、(72.00±14.37)mg/L(P<0.05)。术后3 d,黏膜切除组PGⅠ(130.25±9.14)μg/L、PGⅡ(16.33±2.14)μg/L均高于高频电切组的(102.63±8.55)、(14.20±2.00)μg/L(P<0.05)。黏膜切除组术后并发症发生率2.00%低于高频电切组的19.05%(P<0.05)。结论相较于高频电凝切除术,EMR治疗胃息肉效果显著,可优化患者围术期指标,减轻炎症反应,促进胃黏膜修复,并发症轻且少,较为安全。

Objective To evaluate the clinical efficacy and safety of different endoscopic procedures in the treatment of gastric polyps.Methods 92 patients with gastric polyps were divided into mucosa resection group(50 cases)and high-frequency electroresection group(42 cases)by different surgical procedures.The high-frequency electroresection group was treated with high-frequency electroresection,and the mucosa resection group was treated with endoscopic mucosal resection(EMR).Patients in both groups were compared in terms of perioperative indexes(operation time,intraoperative blood loss,time to start liquid feeding,length of hospital stay),clinical efficacy,levels of inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)],serum factors[pepsinogenⅠ(PGⅠ),pepsinogenⅡ(PGⅡ)]levels and complications(mucosal muscle injury,bleeding,abdominal pain).Results The operative time of the mucosa resection group was(12.40±5.00)min,the time to start liquid feeding was(1.65±0.31)d,and the length of hospital stay was(6.13±2.00)d,which were shorter than(14.58±4.10)min,(2.09±0.41)d,(7.26±1.45)d of the high-frequency electroresection group;the intraoperative blood loss of the mucosa resection group was(7.10±2.00)ml,which was less than(12.36±3.15)ml of the high-frequency electroresection group(P<0.05).The total effective rate of mucosa resection group was 88.00%,which was higher than 71.43%of high-frequency electroresection group(P<0.05).3 d after surgery,the mucosa resection group had IL-6 of(178.96±13.05)pg/ml and CRP of(52.78±6.91)mg/L,which were lower than(235.22±16.78)pg/ml and(72.00±14.37)mg/L in the high-frequency electroresection group(P<0.05).3 d after surgery,the mucosa resection group had PGⅠof(130.25±9.14)μg/L and PGⅡof(16.33±2.14)μg/L,which were higher than(102.63±8.55)and(14.20±2.00)μg/L in the high-frequency electroresection group(P<0.05).The incidence of postoperative complications in the mucosa resection group was 2.00%,which was lower than 19.05%in the high-frequency electroresection group(P<0.05).Conclusion Compared with high-frequency electroresection,EMR has a significant effect in the treatment of gastric polyps,which can optimize the perioperative indicators of patients,reduce inflammatory response,promote the repair of the gastric mucosa,and have fewer and lesser complications,which is relatively safe.