圈套器冷切除术和内镜黏膜切除术治疗阑尾口结肠腺瘤的疗效对比分析

Comparative analysis of the efficacy of cold snare polypectomy and endoscopic mucosal resection in treatment of colonic adenoma in proximity to the orifice of appendix

摘要:

目的 探讨圈套器冷切除术（CSP）与内镜黏膜切除术（EMR）治疗阑尾口结肠腺瘤的可行性、有效性和安全性。方法 收集2018年1月－2023年1月该院收治的56例阑尾口结肠腺瘤患者的临床资料，分为CSP组（经CSP治疗，41例）和EMR组（经EMR治疗，15例）。分析两组患者临床病理特征和结局。主要结局为术后并发症，包括：出血、穿孔及术后阑尾炎，次要结局为：整块切除率、完全切除率及局部复发率。结果 CSP组手术时间较EMR组短，治疗费用较EMR组少，差异均有统计学意义（P < 0.05）。CSP组适用病灶直径较EMR组小，病灶性质为管状腺瘤占比明显多于EMR组；两组患者进镜时间、肠道准备评分、住院时间、病灶形态和病灶类型比较，差异均无统计学意义（P > 0.05）。两组患者均未见穿孔和术后阑尾炎事件，CSP组术后出现迟发性出血1例，但术后可以自愈，无需内镜干预。两组患者完整切除率均为100.0%；CSP组整块切除率为100.0%，明显高于EMR组的86.7%，差异有统计学意义（P < 0.05）。CSP组局部复发率为2.4%（1/41），EMR组未见局部复发（0/15），差异无统计学意义（P > 0.05）。结论 CSP和EMR治疗阑尾口结肠腺瘤都具有安全、有效的特点。与EMR比较，CSP更多地应用于直径较小的管状腺瘤，具有经济和省时等特点，但同时也存在复发的风险。EMR适用范围更广，但价格和手术时间存在劣势，个别病例需分块切除。临床需根据情况，选择具体术式。

Abstract:

Objective To investigate the feasibility, efficacy and safety of cold snare polypectomy (CSP) and endoscopic mucosal resection (EMR) in treatment of colonic adenoma in proximity to the orifice of appendix.Methods Clinical data of 41 cases of colonic adenoma in the orifice of appendix treated with CSP (CSP group) and 15 cases treated with EMR (EMR group) from January 2018 to January 2023 were collected. The clinicopathological features and outcomes were analyzed. The main outcome was postoperative complications, including bleeding, perforation and postoperative appendicitis, while the secondary outcome was the total resection rate, block resection rate and local recurrence rate.Results The operation time and treatment cost of CSP group were shorter than EMR group, and the differences were statistically significant (P < 0.05). The diameter of applicable lesions in CSP group was smaller than that in EMR group, and the proportion of lesions with tubular adenoma was significantly higher than that in EMR group. There were no significant differences in the time of admission, intestinal preparation score, length of stay, lesion morphology and lesion type between the two groups (P > 0.05). Perforation and postoperative appendicitis were not observed in both groups, and delayed postoperative hemorrhage occurred in 1 case in the CSP group, but it could heal itself after surgery without endoscopic intervention. The complete resection rate was 100.0% in both groups. The total removal rate of CSP group was 100.0%, which was significantly higher than that of EMR group (86.7%), and the difference was statistically significant (P < 0.05). The local recurrence rate was 2.4% (1/41) in CSP group, and no local recurrence was observed in EMR group (0/15), with no statistical significance (P > 0.05).Conclusion CSP and EMR are safe and effective in the treatment of colonic adenoma in proximity to the orifice of appendix, and they are trustworthy. Compared with EMR, CSP is more applied to small diameter tubular adenomas, which has the characteristics of economy and time saving, but at the same time there is the risk of recurrence. EMR obviously has a wider application range, but there is a disadvantage in price and time, and individual cases need to be segmented resection.