内镜黏膜下剥离术治疗早期结直肠癌的应用价值与安全性评估*

Application value and safety evaluation of ESD in treatment of colorectal precancerous lesions*

摘要:

探讨内镜黏膜下剥离术（ESD）治疗早期结直肠癌的应用价值和安全性。方法 回顾性分析2014年5月-2016年5月该院收治的早期结直肠癌患者的临床资料。根据手术方式的不同，分为内镜下黏膜切除术（EMR）组和ESD组，比较两组患者临床疗效、安全性及炎性指标水平的变化情况。结果 共纳入126例研究对象，患者病变直径≥2 cm时，手术时间均长于病变直径<2 cm（P <0.05）。在不同病变直径中，ESD组患者手术时间均长于EMR组，病变整块切除率和完全切除率均高于EMR组（P <0.05）。在病变直径≥2 cm时，EMR组患者病变整块切除率和完全切除率低于病变直径<2 cm（P <0.05）。术前两组患者C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及CD3+、CD4+水平比较差异无统计学意义（P >0.05），术后1周，ESD组患者CRP、TNF-α、IL-6水平低于EMR组，CD3+和CD4+水平高于EMR组（P <0.05）。两组患者术后感染、穿孔、吻合口瘘发生率和复发率比较差异无统计学意义（P >0.05）。ESD组患者出血发生率高于EMR组（P <0.05）。结论 ESD治疗早期结直肠癌的疗效显著，对机体应激反应较小，术后复发率低，但出血率较EMR组高，应加强监测。

Abstract:

To explore the application value and evaluate the safety of ESD in treatment of early colorectal cancer. Methods The clinical data of patients with early colorectal cancer admitted from May 2014 to May 2016 were retrospectively analyzed. According to the different operation methods, the patients were divided into EMR group and ESD group. The changes of clinical efficacy, safety and inflammatory index level were compared between the two groups. Results 126 patients were involved in the study. The operative time was longer than that of the lesion diameter < 2 cm (P < 0.05) when the lesion diameter was more than 2 cm. The operative time of ESD group was longer than that of EMR group. The resection rate and complete resection rate of lesion were higher than that of EMR group (P < 0.05). When the diameter of lesion was ≥ 2 cm, the operation time of ESD group was longer than that of EMR group. In EMR group, the whole and complete resection rate were lower than that in the diameter less than 2 cm (P < 0.05). There was no significant difference in the levels of TNF- α IL-6 and CD3+ and CD4+ between the two groups before operation (P > 0.05), but one week after operation, the levels of CRP, TNF- α and IL-6 was lower than that of EMR group (P < 0.05), while the levels of CD3+ and CD4+ were higher (P < 0.05). There was no significant difference in the incidence and recurrence rate of anastomotic leakage (P > 0.05). The incidence of hemorrhage in ESD group was higher than that in EMR group (P < 0.05). Conclusion ESD was effective in treatment of early colorectal cancer. The stress response was small and the recurrence rate was low, but the bleeding rate was higher than that in EMR group, so the monitoring should be strengthened.