早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较

Comparison of the effect of different surgical procedures in the early stage of colorectal cancer and early cancer patients

摘要:

目的??比较内镜下黏膜切除术（EMR）与内镜下黏膜剥离术（ESD）在结直肠癌前病变与早期癌患者中的应用效果。方法?选取2010年1月-2015年1月该院收治的116例早期结直肠癌患者与结直肠腺瘤患者为研究对象。其中，61例患者采用EMR治疗，为EMR组，55例采用ESD治疗，为ESD组。比较EMR与ESD在结直肠癌前病变与早期癌患者中的应用效果。结果?EMR组患者的手术时间明显短于ESD组患者，两组患者的病理情况、异型增生程度的差异无统计学意义（P >0.05）。ESD组病变最大径≥2 cm的整块切除和病变最大径≥2 cm的组织治愈性切除的患者明显多于EMR组，差异有统计学意义（P <0.05）。ESD组病变最大直径≥2 cm的患者明显多于EMR组，差异有统计学意义（P <0.05）。EMR组和ESD组患者并发症总发生率分别为6.56%和23.63%，差异有统计学意义（P <0.05）。EMR组和ESD组患者的复发率分别为5（8.20%）例和3（5.45%）例，差异无统计学意义（P >0.05）。ESD术后出现并发症的危险因素为操作经验和病变大小（P <0.05）。结论?ESD术和EMR术均能较好的整块切除病变最大径≥2 cm的早期结直肠癌与结直肠腺瘤，术后复发率较低。ESD术相对于EMR术更适合较大的病变，但术后复发率较高，且手术医师的操作经验和病变大小为ESD术后发生并发症的危险因素，应加强监测。

Abstract:

Objective?To compare endoscopic mucosal resection (endoscopic mucosal resection, EMR) and endoscopic submucosal dissection (endoscopic submucosal dissection, ESD) in colorectal cancer precancerous lesions and early cancer patients in application effect. Methods?116 cases of stage colonic rectal cancer and colorectal adenoma patients from January 2010 to 2015 were divided into EMR group: 61 patients and ESD group: 55 patients. Then compare the effect prior to the application of colorectal cancer lesions and early cancer patients. Results?EMR group, the operative time was significantly shorter in ESD group of patients, the difference of the two groups of patients with pathological conditions, the degree of dysplasia without statistical significance (P >0.05). ESD lesion group maximum diameter is equal to or larger than 2 cm en bloc resection and pathological maximum diameter is equal to or larger than 2 cm tissue cure resection patients was significantly higher than that of the EMR group, the difference was statistically significant (P <0.05). ESD lesion diameter greater than or equal to 2 cm EMR group, the difference was statistically significant (P <0.05). EMR, ESD in patients with the total incidence rates were 6.56 %, 23.63 %, the difference was statistically significant (P <0.05). EMR, ESD in patients with recurrence rates were 5 cases (8.20 %) and 3 cases (5.45 %), the difference was not statistically significance (P >0.05). Complication risk factors for ESD was operation experience and the size of the lesion (P <0.05). Conclusion?ESD and EMR can better en bloc resection of the lesion of maximum diameter is equal to or larger than 2 cm of early colorectal cancer and colorectal adenoma, postoperative recurrence rate is low. ESD operation, but a higher recurrence rate, and surgeons of operational experience and the size of the lesion after ESD occurred complications and risk factors, we should strengthen the monitoring.