结直肠癌合并高风险性腺瘤患者内镜下手术时机分析  

Analysis of the timing of endoscopic surgery in patients with colorectal cancer and high-risk adenoma

作　　者：霍江波 牛应林[2] 于淑霞 陈娟 王珺 王蕾 Jiang-bo Huo;Ying-lin Niu;Shu-xia Yu;Juan Chen;Jun Wang;Lei Wang(Department of Gastroenterology,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China;Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学大兴教学医院消化内科,北京102600 [2]首都医科大学附属北京友谊医院消化科,北京100050

出　　处：《中国内镜杂志》2022年第6期41-46,共6页China Journal of Endoscopy

摘　　要：目的探究结直肠癌合并高风险性腺瘤患者内镜下手术时机。方法选取2016年1月-2021年1月该院收治的行内镜下手术的结直肠癌合并高风险性腺瘤患者共计125例,根据手术时机不同,分为A组64例和B组61例。A组:患者在手术前完成术前检查,符合手术指征后,择期进行外科结直肠癌手术,手术后3~6个月,择期进行内镜下高风险性腺瘤手术;B组:患者在手术前完成术前检查,符合手术指征后,择期进行内镜下高风险性腺瘤手术,在术后2周内,进行外科结直肠癌手术。采用自制调查量表,对患者的年龄、性别、手术出血量、手术时间、高风险性腺瘤部位、大小和个数等进行记录;通过复诊的方式,对患者病情进展进行随访。结果两组患者在年龄、性别、手术时间及术中出血量等方面比较,差异均无统计学意义(P>0.05);两组患者在疾病类型、结直肠癌病灶直径、腺瘤直径、腺瘤发生部位及病理类型等方面比较,差异均无统计学意义(P>0.05);A组患者二次手术12例(18.8%),多于B组的2例(3.3%),差异有统计学意义(P<0.05);多因素Logistic分析得出,先择期进行外科结直肠癌手术,手术后3~6个月,择期进行内镜下高风险性腺瘤手术,是患者二次手术的独立危险因素(OR=0.324,95%CI:2.65~7.41,P<0.05)。结论结直肠癌合并高风险性腺瘤患者,在择期进行内镜下高风险性腺瘤手术后2周内进行外科结直肠癌手术,能够降低患者二次手术的发生率,减轻患者身体创伤,改善预后。Objective To explore the timing of endoscopic surgery for patients with colorectal cancer and highrisk adenoma.Methods 125 patients with colorectal cancer and high-risk adenoma from January 2016 to January2021 were selected for endoscopic surgery according to the timing of surgery,it was divided into 64 cases in group A and 61 cases in group B.group A:Patients complete preoperative examinations before surgery,elective surgical colorectal cancer surgery after meeting the surgical indications,and elective endoscopic high-risk adenoma surgery3~6 months after surgery;Group B:patients before surgery after completing the preoperative examination and meeting the surgical indications,elective endoscopic high-risk adenoma surgery will be performed;surgical colorectal cancer surgery will be performed within 2 weeks after surgery.A self-made questionnaire will be used to determine the patient’s age,gender,and surgical blood loss,operation time,high-risk adenoma location,size,number,etc.are recorded.Results There were no statistically significant differences between the two groups of patients in terms of age,gender,operation time,and intraoperative blood loss(P>0.05);the two groups of patients were not statistically significant in terms of disease type,colorectal cancer lesion diameter,adenoma diameter.The tumor location and pathological type were not statistically significant(P>0.05);12 patients in group A(18.8%)were underwent secondary surgery,which was more than the 2 patients in group B(3.3%).The difference was significant statistical significance(P<0.05).Multivariate Logistics analysis concluded that elective surgical colorectal cancer surgery and elective endoscopic high-risk adenoma surgery 3~6 months after surgery are independent risk factors for patients with secondary surgery(OR=0.324,95%CI:2.65~7.41,P<0.05).Conclusion In summary,patients with colorectal cancer with high-risk adenoma underwent surgical colorectal cancer surgery within 2 weeks after elective endoscopic high-risk adenoma surgery can reduce the inci

关 键 词：结直肠癌 高风险性腺瘤 危险因素 手术时机 内镜 

分 类 号：R735.3[医药卫生—肿瘤]