切缘热消融降低结肠腺瘤EMR分片切除术后复发的随机对照研究  

Thermal ablation on the mucosal defect margin reduces recurrence of colonic adenoma after endoscopic mucosal resection:a randomized controlled trial

作　　者：陆丽娜 蒋国法 黄伟 薛海波[2] 陈慧 LU Lina;JIANG Guofa;HUANG Wei;XUE Haibo;CHEN Hui(Department of Gastroenterology,Wenrong Hospital of Jinhua,Jinhua 321000,China;不详)

机构地区：[1]金华文荣医院消化内科,321000 [2]温州医科大学附属第一医院消化内科

出　　处：《浙江医学》2025年第6期610-614,I0005,共6页Zhejiang Medical Journal

摘　　要：目的探讨切缘热消融对结肠腺瘤行内镜下黏膜切除术(EMR)分片切除术后复发风险的影响。方法采用前瞻性随机对照研究方法,选取2021年1月1日至2024年1月25日在金华文荣医院接受治疗的侧向发育型结肠腺瘤(直径≥20 mm)患者79例。患者根据计算机生成的随机数列表2∶1随机分配至观察组或对照组。53例观察组患者接受EMR联合切缘热消融治疗,26例对照组患者接受常规EMR治疗。比较两组患者腺瘤特征、围术期指标、术后6个月腺瘤复发情况;分析EMR术后腺瘤复发的影响因素。结果两组患者的腺瘤大小、部位、组织学类型与异型增生特征比较差异均无统计学意义(均P>0.05),基线特征具有可比性。观察组患者与对照组患者的手术时间、术中出血率、术后出血率、深层肠壁损伤率比较差异亦均无统计学意义[(27.3±4.0)min比(25.5±3.9)min、20.8%比23.1%、2.9%比4.0%、2.9%比0,均P>0.05]。观察组患者术后6个月腺瘤复发率低于对照组(5.7%比23.1%,P<0.05)。切缘热消融是EMR术后腺瘤复发的独立保护因素(P<0.05)。结论切缘热消融技术显著降低了结肠腺瘤EMR分片切除术后的复发风险,可常规应用于结肠大腺瘤的治疗中。Objective To investigate the effect of mucosal defect margin thermal ablation on the risk of recurrence of colonic adenoma after endoscopic mucosal resection(EMR).Methods This was a prospective randomized controlled trial.From January 1,2021,to January 25,2024,a total of 79 patients with colonic lateral spreading lesions(LSLs;≥20 mm)who underwent EMR at Wenrong Hospital of Jinhua were 2∶1 randomly assigned according to a computer-generated list of random numbers to an observation group(EMR combined with thermal ablation,n=53)and a control group(conventional EMR,n=26).Adenoma characteristics,perioperative indicators,and adenoma recurrence at 6 months postoperatively were compared between the two groups;factors influencing adenoma recurrence after EMR were investigated.Results There were no statistically significant differences in adenoma size,location,histological type,and dysplasia between the two groups(all P>0.05),indicating that the baseline characteristics were comparable.Similarly,there were no statistically significant differences in operative time,intraoperative and postoperative bleeding rates,and deep intestinal wall injury rate between the two groups[(27.3±4.0)min vs.(25.5±3.9)min,20.8%vs.23.1%,2.9%vs.4.0%,and 2.9%vs.0,respectively;all P>0.05].The adenoma recurrence rate at 6 months postoperatively in the observation group was lower than that of the control group(5.7%vs.23.1%,P<0.05).Thermal ablation on the resection margin was an independent protective factor for adenoma recurrence after EMR(P<0.05).Conclusion Thermal ablation on the mucosal defect margin significantly reduces adenoma recurrence after EMR,which should be universally used for the management of large LSLs.

关 键 词：结肠腺瘤 内镜下黏膜切除术 切缘热消融 复发 

分 类 号：R73[医药卫生—肿瘤]