摘要
目的比较内镜下冷圈套息肉切除术(CSP)与内镜下黏膜切除术(EMR)治疗结直肠亚蒂型息肉的安全性及疗效。方法选取2020年1月至2021年10月杭州师范大学附属医院收治的结直肠直径6~20 mm亚蒂型息肉患者200例,共246枚息肉,其中CSP组100例(122枚息肉)采用CSP治疗,EMR组100例(124枚息肉)采用EMR治疗。主要观察指标为迟发性息肉切除术后出血(DPPB)率,次要观察指标为术中即刻出血的发生率、术中及术后的穿孔率、手术时间、术后息肉复发率和新生息肉发现率。对两组10~20 mm的息肉进一步分析,比较息肉直径、息肉位置、术后病理诊断、手术时间、完整切除数、内镜下成功切除数、操作失败后追加治疗数及并发症等指标。结果两组息肉大小、位置及病理类型比较差异均无统计学意义(均P>0.05)。CSP组术中出血率高于EMR组(7.4%比0.8%,P<0.05),但CSP组术后延迟性出血率较EMR组(0比6.5%)下降(P<0.05)。CSP组手术时间较EMR组缩短[(2.6±0.7)min比(3.8±0.6)min,P<0.01]。术后随访6个月,两组患者均未出现息肉复发,两组新生息肉发现率比较差异无统计学意义(P>0.05)。两组10~20 mm息肉(CSP组51枚,EMR组48枚)的息肉直径、息肉位置、术后病理、完整切除数、内镜下成功切除数及操作失败后追加治疗数比较差异均无统计学意义(均P>0.05),CSP组手术时间较EMR组缩短(P<0.01),术中出血发生率较EMR组高(P<0.05),但CSP组术后延迟性出血发生率较EMR组低(P<0.05)。结论对于6~20 mm的结直肠亚蒂型息肉,CSP较传统EMR更安全,且手术时间短,值得临床推广应用。
Objective To compare the safety and efficacy of endoscopic cold snare polypectomy(CSP)and endoscopic mucosal resection(EMR)in the treatment of sub-pedicle colorectal polyps.Methods A total of 200 patients with 246 sub-pedicle colorectal polyps(6-20 mm)admitted to the Affiliated Hospital of Hangzhou Normal University from January 2020 to October 2021 were selected.Among them,100 patients(122 polyps)in the CSP group were treated with CSP,and 100 patients(124 polyps)in the EMR group were treated with EMR.The primary outcome measure was the delayed post-polypectomy bleeding,and the secondary outcome measures were the incidence of immediate intraoperative bleeding,intraoperative and postoperative perforation rate,operation time,and postoperative polyp neogenesis and recurrence rates.The polyps of 10-20 mm in the two groups were further analyzed,and the polyp diameter,polyp location,postoperative pathological diagnosis,operation time,number of complete resection,number of successful endoscopic resection,number of additional treatment after operation failure and complications were compared.Results There was no significant difference in the size,location and pathological type of polyps between the two groups(all P>0.05).The immediate intraoperative bleeding rate in the CSP group was higher than that in the EMR group(7.4%vs.0.8%,P<0.05),but the postoperative delayed bleeding rate in the CSP group was lower than that in EMR group(0 vs.6.5%,P<0.05).The operation time of CSP group was shorter than that of EMR group[(2.6±0.7)min vs.(3.8±0.6)min,P<0.01].After 6 months of follow-up,there was no recurrence of polyps in the two groups,and there was no significant difference in polyp neogenesis between the two groups(P>0.05).There was no significant difference between the two groups in the polyp diameter,polyp location,postoperative pathology,number of complete resection,number of successful endoscopic resection and number of additional treatments after operation failure of 10-20 mm polyps(51 in the CSP group and 48 in the EMR group)(all P>0.05).The operation time in the CSP group was shorter than that in the EMR group(P<0.01),and the incidence of immediate intraoperative bleeding was higher than that in the EMR group(P<0.05),but the incidence of DPPB in the CSP group was lower than that in the EMR group(P<0.05).Conclusion For 6-20 mm sub-pedicle colorectal polyps,CSP is safer and shorter in operation time than traditional EMR,which is worthy of clinical promotion.
作者
李国栋
金娟
何承海
来志超
徐阳
王可洋
孙丽伟
LI Guodong;JIN Juan;HE Chenghai;LAI Zhichao;XU Yang;WANG Keying;SUN Liwei(Department of Gastroenterology,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;不详)
出处
《浙江医学》
CAS
2022年第20期2189-2193,I0005,共6页
Zhejiang Medical Journal
