口袋法内镜黏膜下剥离术与内镜下黏膜切除术治疗早期结直肠癌的短期疗效对比  

Short⁃term outcomes of pocket endoscopic submucosal dissection and endoscopic mucosal resection in treatment of early colorectal cancer

作　　者：吴欣遥 赵芷藜 蒋丹丹 龙晓奇 杨彬[1] Wu Xinyao;Zhao Zhili;Jiang Dandan;Long Xiaoqi;Yang Bin(Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院,四川遂宁629000

出　　处：《海军医学杂志》2025年第4期383-386,共4页Journal of Navy Medicine

基　　金：中国消化道早癌医师共同成长计划科研项目(GTCZ-2020-SC-S1-0011)。

摘　　要：目的对比早期结直肠癌治疗中口袋法内镜黏膜下剥离术(ESD)与内镜下黏膜切除术(EMR)的短期疗效及术后并发症发生情况。方法前瞻性选取遂宁市中心医院2020年6月至2022年6月收治的早期结直肠癌患者110例,采用随机数字表法分为A、B组,其中A组58例行口袋法ESD,B组52例行EMR。对比2组患者手术相关指标,术前、术后3 d炎症因子[白细胞介素⁃6(IL⁃6)、肿瘤坏死因子⁃α(TNF⁃α)、C反应蛋白(CRP)]水平,以及术后生活质量指数量表(QL⁃Index)评分;观察2组患者并发症发生情况。结果A组手术时间、住院时间、首次排气及排便时间、术中出血量均短/低于B组,完全切除及整块切除率均高于B组(P<0.05);术后3 d,2组患者IL⁃6、TNF⁃α、CRP水平均上升,且A组低于B组(P<0.05);A组QL⁃Index评分中活动、日常活动、健康、总体情况及总分高于B组(P<0.05)。A组并发症发生率高于B组,但差异无统计学意义(P>0.05)。结论口袋法ESD应用在早期结直肠癌患者中临床疗效较EMR显著,能够有效促进患者术后康复进程,提升切除效果,降低术后炎症水平并提高患者生存质量,且未见明显的并发症,值得临床参考借鉴。Objective To compare the short⁃term outcomes and postoperative complications of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early colorectal cancer.Methods A total of 110 patients with early colorectal cancer who were admitted to Suining Central Hospital from June 2020 to June 2022 were prospectively enrolled and randomly assigned to two groups by random number table.Of them,58 patients underwent ESD and 52 patients underwent EMR.Operation related indexes,inflammatory factors(interleukin⁃6[IL⁃6],tumor necrosis factor⁃α[TNF⁃α],and C⁃reactive protein[CRP])before operation and 3 days after operation,and postoperative quality of life index(QL⁃Index)were compared between the two groups.The complications of the two groups were observed.Results The operation time,hospital stay,postoperative exhaust time,defecation time,and intraoperative blood loss in ESD group were lower than those in EMR group,and the rates of complete resection and en bloc resection in ESD group were higher than those in EMR group(P<0.05).The levels of IL⁃6,TNF⁃αand CRP were increased 3 d after operation in both groups,but the levels of IL⁃6,TNF⁃αand CRP in ESD group were lower than those in EMR group(P<0.05).The total score of QL⁃Index and the scores of activity,daily activities,health,and overall situation in ESD group were significantly higher than those in EMR group(P<0.05).The incidence of complications in ESD group was higher than that in EMR group,without significant difference(P>0.05).Conclusion The pocket ESD can effectively promote postoperative rehabilitation,increase resection rate,reduce postoperative inflammation,and improve the quality of life of patients with early colorectal cancer,and there is no obvious complication.

关 键 词：口袋法 内镜黏膜下剥离术 内镜下黏膜切除术 结直肠癌 

分 类 号：R735.6[医药卫生—肿瘤]