结直肠癌合并高风险性腺瘤患者内镜下手术时机分析

Analysis of the timing of endoscopic surgery in patients with colorectal cancer and high-risk adenoma

摘要:

目的 探究结直肠癌合并高风险性腺瘤患者内镜下手术时机。方法 选取2016年1月－2021年1月该院收治的行内镜下手术的结直肠癌合并高风险性腺瘤患者共计125例，根据手术时机不同，分为A组64例和B组61例。A组：患者在手术前完成术前检查，符合手术指征后，择期进行外科结直肠癌手术，手术后3～6个月，择期进行内镜下高风险性腺瘤手术；B组：患者在手术前完成术前检查，符合手术指征后，择期进行内镜下高风险性腺瘤手术，在术后2周内，进行外科结直肠癌手术。采用自制调查量表，对患者的年龄、性别、手术出血量、手术时间、高风险性腺瘤部位、大小和个数等进行记录；通过复诊的方式，对患者病情进展进行随访。结果 两组患者在年龄、性别、手术时间及术中出血量等方面比较，差异均无统计学意义（P > 0.05）；两组患者在疾病类型、结直肠癌病灶直径、腺瘤直径、腺瘤发生部位及病理类型等方面比较，差异均无统计学意义（P > 0.05）；A组患者二次手术12例（18.8%），多于B组的2例（3.3%），差异有统计学意义（P < 0.05）；多因素Logistic分析得出，先择期进行外科结直肠癌手术，手术后3～6个月，择期进行内镜下高风险性腺瘤手术，是患者二次手术的独立危险因素（OR＾ = 0.324，95%CI：2.65～7.41，P < 0.05）。结论 结直肠癌合并高风险性腺瘤患者，在择期进行内镜下高风险性腺瘤手术后2周内进行外科结直肠癌手术，能够降低患者二次手术的发生率，减轻患者身体创伤，改善预后。

Abstract:

Objective To explore the timing of endoscopic surgery for patients with colorectal cancer and high-risk adenoma.Methods 125 patients with colorectal cancer and high-risk adenoma from January 2016 to January 2021 were selected for endoscopic surgery according to the timing of surgery, it was divided into 64 cases in group A and 61 cases in group B. group A: Patients complete preoperative examinations before surgery, elective surgical colorectal cancer surgery after meeting the surgical indications, and elective endoscopic high-risk adenoma surgery 3～6 months after surgery; Group B: patients before surgery after completing the preoperative examination and meeting the surgical indications, elective endoscopic high-risk adenoma surgery will be performed; surgical colorectal cancer surgery will be performed within 2 weeks after surgery. A self-made questionnaire will be used to determine the patient’s age, gender, and surgical blood loss, operation time, high-risk adenoma location, size, number, etc. are recorded.Results There were no statistically significant differences between the two groups of patients in terms of age, gender, operation time, and intraoperative blood loss (P > 0.05); the two groups of patients were not statistically significant in terms of disease type, colorectal cancer lesion diameter, adenoma diameter. The tumor location and pathological type were not statistically significant (P > 0.05); 12 patients in group A (18.8%) were underwent secondary surgery, which was more than the 2 patients in group B (3.3%). The difference was significant statistical significance (P < 0.05). Multivariate Logistics analysis concluded that elective surgical colorectal cancer surgery and elective endoscopic high-risk adenoma surgery 3 ~ 6 months after surgery are independent risk factors for patients with secondary surgery (OR＾ = 0.324, 95%CI: 2.65 ~ 7.41, P < 0.05).Conclusion In summary, patients with colorectal cancer with high-risk adenoma underwent surgical colorectal cancer surgery within 2 weeks after elective endoscopic high-risk adenoma surgery can reduce the incidence of secondary operations, reduce patients’ injury and improve prognosis.