内镜黏膜下剥离与腹腔镜下切除结直肠巨大宽蒂/广基息肉的临床观察*

Clinical observation of endoscopic submucosal dissection in treating wide base colonic polyps comparing with laparoscopic surgery*

摘要:

目的??比较内镜黏膜下剥离术（ESD）与腹腔镜下手术治疗结直肠巨大宽蒂/广基息肉的临床治疗效果。方法?术前结肠镜检查诊断结直肠巨大宽蒂/广基息肉（蒂宽或基底部>2.0 cm）69例，根据患者知情选择意愿，其中41例选择ESD治疗（治疗组），28例选择腹腔镜下治疗（对照组），术后6个月首次复查胃肠镜，对比两组患者临床效果与医疗费用。结果?两组患者治疗成功率均为100.00%，其中治疗组1例患者术后病理提示癌变追加外科治疗，对照组1例患者术中快速冰冻病理提示癌变追加淋巴结清扫术和扩大切除范围。治疗组和对照组平均手术时间分别为（85.00±36.50）和（110.00±45.70）min（P <0.05）；治疗组住院时间（10.69±3.09）d较对照组（11.61±6.41）d缩短，组间比较差异有统计学意义（P <0.05）；治疗组治疗费用（1.57±0.27）万元低于对照组（3.06±0.59）万元，组间比较差异有统计学意义（P <0.05）。治疗组术后消化道出血1例；对照组术后不完全肠梗阻2例，术后术口感染1例，肠瘘1例。治疗组并发症发生率2.43%，低于对照组14.29%，组间比较差异有统计学意义（P <0.05）。两组患者术后6个月结肠镜检查均未发现复发病例。结论?ESD术和腹腔镜下手术均是胃肠道巨大宽蒂/广基息肉治疗的安全有效方法，但均需警惕息肉癌变并追加治疗，ESD术具有创伤少、费用低等优势。

Abstract:

Objective?To evaluate the clinical effects and complications in treating colonic polyps between endoscopic submucosal dissection and laparoscopy.?Methods?69 colonic polyps patients diagnosed by colonoscopy with the basal body diameter of the colonic polyp >2.0 cm were enrolled in this study. All the patients were divided into study group (n = 41) and control group (n = 28) according to patients’ decision, and then treated with ESD and laparoscopic surgery separately. After treatment, all the patients were followed up and repeated colonoscopy after 6 months. Clinical data were recorded and analyzed at the end of the research.?Results?Patients were successfully operated in both groups. 1 case in each group was diagnosed of malignant tumor and needed further treatment. The average operation time in study group and the control group was (85.00± 36.50) min and (110.00 ± 45.70) min (P < 0.05), length of hospital stay of the two groups were (10.69 ± 3.09) d and (11.61 ± 6.41) d (P < 0.05), and average cost of hospitalization of the two groups were (15.7 ± 2.7) ten thousand RMB and (30.6 ± 5.9) ten thousand RMB (P < 0.05). Percentage of complications in the study group was 2.43% comparing to 14.29% of control group (P < 0.05). 1 case in the study group complicated with enteron hemorrhage. Complications in the control group was 2 cases of ileus, 1 case of infection, 1 case of intestinal fistula. No recurrence was found in the two groups after 6 months in the repeat colonoscopy.?Conclusion?Both of the two treatments are effective for patients with wide base colonic polyps, but malignant tumor must be cautioned when treating with wide base colonic polyps. Endoscopic submucosal dissection requires proficient skill while with less impairment and cost.