圈套器预切开内镜下黏膜切除术在结肠扁平型息肉中的临床应用研究  

Clinical application of pre-cut-endoscopic mucosal resection with a snare device in the treatment of flat polyps of the colon

作　　者：李振涛 陈虎 刘世育 吴传楠 张海涵 李涛 郭雅慧 陈光侠 LI Zhentao;CHEN Hu;LIU Shiyu;WU Chuannan;ZHANG Haihan;LI Tao;GUO Yahui;CHEN Guangxia(Department of Gastroenterology,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou Digestive Disease Research Institute,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属徐州市立医院消化内科,徐州市消化疾病研究所,江苏徐州221000

出　　处：《胃肠病学和肝病学杂志》2025年第1期79-83,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：徐州市重点研发计划项目(KC22095);徐州市卫生健康委员会医学领军人才培养项目(XWRCHT20210025)。

摘　　要：目的探讨圈套器预切开内镜下黏膜切除术(pre-cut-endoscopic mucosal resection,pre-cut-EMR)治疗结肠扁平型息肉的临床效果及安全性。方法回顾性分析2020年1月至2022年12月徐州医科大学附属徐州市立医院内镜中心行内镜治疗的结肠扁平息肉患者80例,其中pre-cut-EMR组40例采用圈套器pre-cut-EMR,ESD组40例采用ESD,比较两组方法的手术时间、一次性完整切除率、钛夹使用数量、手术并发症、首次排便时间、平均住院费用及平均住院时间情况。结果pre-cut-EMR组手术时间、术后首次排便时间及平均住院时间短于ESD组(P<0.05);术中钛夹使用数量及平均住院费用观察组少于ESD组(P<0.05);pre-cut-EMR组一次性完整切除率95.0%低于ESD组97.5%,但差异无统计学意义(P>0.05);手术并发症方面,ESD组术中出血4例、术中穿孔1例、术后出血2例;pre-cut-EMR组术中出血3例,无穿孔及术后出血病例。结论pre-cut-EMR与ESD治疗结肠扁平型息肉效果相当,但pre-cut-EMR手术时间及平均住院时间短,手术并发症发生率及住院平均费用低,有更好临床推广性。Objective To investigate the clinical efficacy and safety of pre-cut-endoscopic mucosal resection(pre-cut-EMR)for the treatment of flat polyps of the colon.Methods A retrospective analysis was conducted on 80 patients with colonic flat polyps who underwent endoscopic treatment at the Endoscopy Center of Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from Jan.2020 to Dec.2022.The pre-cut-EMR group consisted of 40 patients who underwent pre-cut-EMR with a snare device,while the endoscopic mucosal dissection(ESD)group consisted of 40 patients who underwent ESD.The surgical time,complete resection rate,number of titanium clips used,and surgical complications of the two groups were compared First bowel movement time,average hospitalization cost,and average hospitalization days.Results The pre-cut-EMR group had shorter surgical time,first postoperative bowel movement time,and average hospital stay compared to the ESD group(P<0.05).The number of titanium clips used during surgery and the average hospitalization cost in the pre-cut-EMR group were less than those in the ESD group(P<0.05).The one-time complete resection rate of 95.0%in the pre-cut-EMR group was lower than that of 97.5%in the ESD group,and there was no statistically significant difference between the groups(P>0.05).In terms of surgical complications,there were 4 cases of intraoperative bleeding,1 case of intraoperative perforation,and 2 cases of postoperative bleeding in the control group.There were 3 cases of intraoperative bleeding and no cases of perforation or postoperative bleeding in the pre-cut-EMR group.Conclusion Pre-cut-EMR and ESD have similar therapeutic effects on flat polyps of the colon,but the former has shorter surgical time and average hospitalization days,lower incidence of surgical complications and average hospitalization costs,and better clinical applicability.

关 键 词：圈套器 预切开 黏膜切除术 结肠息肉 

分 类 号：R574.62[医药卫生—消化系统]