ESD与EMR治疗早期结直肠癌、癌前病变的手术效果及并发症观察  

Surgical effect and complications of ESD and EMR in the treatment of colorectal cancer and precancerous lesions

作　　者：杨柳[1] 郑舒丹 YANG Liu;ZHENG Shu-dan(Department of Gastroenterology,the Headquarters of Suzhou Municipal Hospital Affiliated to Nanjing Medical University,Jiangsu Povince,Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州市立医院本部消化内科,江苏苏州215000

出　　处：《河北医科大学学报》2024年第2期159-164,共6页Journal of Hebei Medical University

基　　金：江苏省自然科学基金(BK20191172)。

摘　　要：目的探究内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与黏膜切除术(endoscopic mucosal resection,EMR)对早期结直肠癌、癌前病变患者的手术效果及并发症的影响。方法回顾性我院治疗的早期结直肠癌、癌前病变患者120例,根据手术方式分组,对照组55例,观察组65例。对照组行EMR治疗,观察组行ESD手术。对2组患者的手术指标进行比较,观察两组术前及术后7 d的氧化应激水平,术后对患者进行6个月随访,比较其术前及术后的生活质量水平,统计患者术后发生穿孔、感染及出血的情况,并记录患者术后6个月内是否复发。结果与对照组相比,观察组手术时间较长,术中出血量较多,切除的标本厚度及创面直径均大于对照组,差异均有统计学意义(P<0.05)。观察组病灶整块切除率及治愈性切除率与对照组比较,差异无统计学意义(P>0.05)。治疗后,患者的丙二醛(malondialdehyde,MDA)、氧化型谷胱甘肽(glutathione disulfide,GSSG)、皮质醇(cortisol,Cor)水平均有所上升,与术前比较差异有统计学意义(P<0.05),但2组比较差异无统计学意义(P>0.05)。2组术前的生活质量各维度评估结果差异无统计学意义(P>0.05)。经治疗,对患者术后3个月的生活质量再次评估,其生活质量评分均有提高,且观察组患者的升高幅度高于对照组(P<0.05)。观察组穿孔、术中出血、感染的发生率为12.31%,低于对照组(34.55%),术后6个月内,观察组复发1例(1.54%),与对照组复发率(8例14.55%)比较,差异有统计学意义(P<0.05)。结论与EMR相比,对早期结直肠癌、癌前病变患者行ESD治疗,操作难度较大,手术时间较长,但患者术后氧化应激水平变化相当,可以有效降低患者术后复发率,改善术后并发症的发生情况,提高患者生活质量。Objective To explore the effects of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)on the surgical results and complications of patients with early colorectal cancer(CRC)and precancerous lesions.Methods Retrospective analysis was performed on 120 patients with early CRC and precancerous lesions treated in our hospital,who were divided into a control group(n=55)and an observation group(n=65)according to surgical methods.Patients in the control group underwent EMR,and patients in the observation group underwent ESD.The surgical indicators of the two groups were compared,the oxidative stress level of the two groups before surgery and at 7 d after surgery was observed.The patients were followed up for 6 months after surgery,and the quality of life before and after surgery was compared.The occurrence of perforation,infection and bleeding after surgery and presence of recurrence of patients within 6 months after surgery were recorded.Results Compared with the control group,the duration of operation and intraoperative bleeding was longer or more,and the thickness of the resected specimen and the wound diameter were greater than those in the control group,suggesting significant difference(P<0.05).The total resection rate and curative resection rate(58.46%)were higher than those in the control group(60.00%,46.63%),but the difference was not statistically significant(P>0.05).After treatment,the malondialdehyde(MDA),glutathione disulfide(GSSG),cortisol(Cor)levels all increased,which were statistically different(P<0.05),but the difference between two groups was not statistically significant(P>0.05).The differences in the evaluation results of various dimensions of quality of life between two groups before surgery were not statistically significant(P>0.05).After treatment,the quality of life of the patients at 3 months after surgery was evaluated again;the quality of life score was improved,and the increase in the observation group was higher than that in the control group(P<0.05).The incidence of p

关 键 词：结直肠肿瘤 癌前状态 内镜黏膜切除术 

分 类 号：R735.34[医药卫生—肿瘤]