早期结直肠癌及癌前病变内镜治疗效果

Efficacy of endoscopic treatment for early colorectal cancer and precancerous lesions

目的探讨内镜下黏膜切除术(EMR)与内镜下黏膜下剥离术(ESD)在早期结直肠癌及癌前病变治疗中的疗效和差异。方法回顾性分析南京市江宁医院消化内科2020年1月至2024年5月因肠道病变行内镜下治疗且术后病理为早期结直肠癌或高级别上皮内瘤变的655例患者的临床资料,按照手术方式、病灶形态分组分析其疗效。结果EMR被证实适用于直径≤2 cm的病灶和隆起型病变,而ESD被证实适用于直径>2 cm的病灶和侧向发育型病变。ESD组术中并发症发生率显著高于EMR组[21.5%(55/256)vs 7.5%(30/399),χ^(2)=26.933,P<0.01]。在隆起型病灶Is型、Isp型、Ip型中,ESD治疗的术中并发症发生率均显著高于EMR治疗(P<0.01),但治愈性切除率、术后并发症发生率在ESD和EMR治疗间差异均无统计学意义(P>0.05)。对于Ip型病灶,行EMR治疗总体住院时间显著缩短(P<0.05)。Is型、Isp型、Ip型病灶接受EMR治疗的治愈性切除率无明显差异(P>0.05),但Ip型病灶直径>2 cm的比例较Is型和Isp型明显增高(P<0.05)。结论EMR和ESD在早期结直肠癌及癌前病变治疗中各有优势,但对于直径较大的Ip型病灶,行EMR治疗是安全且效优的。

Objective To investigate the efficacy and differences between endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in the treatment of early colorectal cancer and precancerous lesions.Methods A retrospective analysis was conducted on the clinical information of 655 patients who underwent endoscopic treatment for intestinal lesions at the Department of Gastroenterology,Jiangning Hospital,Nanjing,from January 2020 to May 2024,with postoperative pathology indicating early colorectal cancer or high-grade intraepithelial neoplasia.The efficacy was analyzed by grouping according to surgical method and lesion morphology.Results EMR has been shown to suitable for lesions with a diameter≤2 cm and protruding lesions,while ESD has been shown to suitable for lesions with a diameter>2 cm and laterally spreading lesion.The incidence of intraoperative complications in the ESD group was significantly higher than that in the EMR group[21.5%(55/256)vs 7.5%(30/399),χ^(2)=26.933,P<0.01].For Is-type,Isp-type and Ip-type of protruded lesions,the incidence of intraoperative complications of ESD was significantly higher than that of EMR(P<0.01),but the curative resection rates and postoperative complication rates had no statistical significance between ESD and EMR treatment(P>0.05).For Ip-type lesions,the overall hospital stay was significantly shorted with EMR treatment(P<0.05).There was no significant difference in curative resection rates for Is-type,Isp-type,and Ip-type lesions treated with EMR(P>0.05),but the proportion of Ip-type lesions with a diameter>2 cm was significantly higher than that of Is-type and Isp-type lesions(P<0.05).Conclusion Both EMR and ESD have their advantages in the treatment of early colorectal cancer and precancerous lesions,but for Ip-type lesions with larger diameters,EMR treatment is safe and effective.