EMR与ESD治疗早期肠癌和高级别上皮内瘤变的临床对比

Clinical comparison of EMR and ESD in the treatment of early intestinal cancer and high-grade intraepithelial neoplasia

目的探讨高级别上皮内瘤变以及早期肠癌患者分别应用内镜下黏膜切除术(EMR)与内镜下黏膜剥离术(ESD)的效果。方法选取2021年2月至2023年2月肇庆市第一人民医院消化内科收治的高级别上皮内瘤变以及早期肠癌患者115例,根据手术方法不同分为观察组(n=91)与对照组(n=24)。对照组患者接受ESD治疗,观察组患者接受EMR治疗。手术结束后,收集两组患者围手术期情况,并比较整块切除率、完整切除率、治愈性切除率以及并发症的情况。结果两组患者术后24 h出血发生率比较,差异无统计学意义(P>0.05);观察组手术时间及术后住院时间均短于对照组,观察组的住院费用也低于对照组,差异有统计学意义(P<0.05)。观察组患者整块切除率、完整切除率、治愈性切除率高于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论与ESD相比,EMR治疗早期肠癌和高级别上皮内瘤变的效果确切,能够提高整块切除率、完整切除率和治愈性切除率,且能够促进患者围手术期的恢复,缩短住院时间,减少住院费用,并不会增加并发症的发生风险,具有一定的临床实用价值,值得推广应用。

Objective To investigate the effect of endoscopic mucosal resection(EMR)and endoscopic mucosal dissection(ESD)in patients with high-grade intraepithelial neoplasia and early intestinal cancer.Methods A total of 115 patients with high-grade intraepithelial neoplasia and early intestinal cancer admitted to the Department of Gastroenterology,the First People’s Hospital of Zhaoqing from February 2021 to February 2023 were selected and randomly divided into an observation group(n=91)and a control group(n=24)according to different surgical methods.Patients in the control group received ESD operation,while patients in the observation group received EMR operation.After the operation,the perioperative situation of the two groups was collected,and the overall resection rate,complete resection rate,curative resection and complications were compared.Results There was no statistically significant difference in the incidence of bleeding 24 hours after surgery between the two groups of patients(P>0.05).The observation group had shorter surgical duration and postoperative hospitalization days than the control group,and the hospitalization expenses of the observation group were also lower than those of the control group,with statistically significant differences(P<0.05).The overall resection rate,complete resection rate,and curative resection rate of the observation group were higher than those of the control group,with statistically significant differences(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).Conclusion In contrast to ESD,EMR demonstrates efficacy in the management of early colorectal carcinoma and advanced intraepithelial lesions,enhancing the rates of intact removal,total excision,and therapeutic excision.This method also facilitates quicker patient recovery in the postoperative phase,reduces the duration of hospital stay,and cuts down on inpatient expenses,without elevating the likelihood of postoperative complications.Its clinical utility is evident,making it a technique that merits broader adoption and deployment.