冷圈套息肉切除术与内镜黏膜切除术联合氩等离子体凝固术治疗结肠息肉的临床疗效及安全性比较

Comparison of clinical efficacy and safety of cold snare polypectomy and the combination of endoscopic mucosal resection and argon-plasma coagulation in treating colon polyps

摘要:

目的 探究冷圈套息肉切除术（CSP）与内镜黏膜切除术（EMR）联合氩等离子体凝固术（APC）治疗结肠息肉的临床疗效及安全性。方法 选择2022年3月－2023年6月该院收治的结肠息肉患者80例，随机将患者分为联合手术组（采用EMR+APC治疗，40例）和CSP组（采用CSP治疗，40例）。比较两组患者围手术期指标、临床疗效、疼痛程度、炎症因子水平和安全性。结果 CSP组息肉切除时间和手术总时间明显短于联合手术组，差异均有统计学意义（P < 0.05）；CSP组术后24 h视觉模拟评分法（VAS）评分明显低于联合手术组，差异有统计学意义（P < 0.05）；两组患者术后1 d白细胞介素-6（IL-6）和白细胞介素-8（IL-8）水平明显高于术前，且联合手术组明显高于CSP组，差异均有统计学意义（P < 0.05）；两组患者术中出血量、住院时间、临床疗效和术后72 h VAS评分比较，差异均无统计学意义（P > 0.05）；联合手术组并发症发生率为15.00%，CSP组发生率为5.00%，差异无统计学意义（P > 0.05）。结论 EMR联合APC和CSP两种手术切除方案，均能有效地改善结肠息肉患者症状，提高临床疗效，且不良反应发生率均较低，安全性高；但CSP较EMR联合APC，能加快息肉切除速度，缩短手术时间，减轻患者术后早期疼痛程度，降低炎症因子水平。

Abstract:

Objective To investigate the clinical efficacy and safety of cold snare polypectomy (CSP) and the combination of endoscopic mucosal resection (EMR) and argon-plasma coagulation (APC) in treating colon polyps.Methods From March 2022 to June 2023, 80 patients with colon polyps were randomly grouped into the combined surgery group (treated with EMR + APC, 40 cases) and the CSP group (treated with CSP, 40 cases). Two groups were compared in terms of perioperative indicators, clinical efficacy, pain level, inflammatory cytokine levels, and safety.Results The polyp resection time and total operation time in the CSP group were significantly shorter than those in the combined operation group, and the differences were statistically significant (P < 0.05). The visual analogue scale (VAS) score of the CSP group 24 h after surgery was significantly lower than that of the combined surgery group, and the difference was statistically significant (P < 0.05). The levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in both groups of patients 1 day after the operation were significantly higher than those before the operation, and the levels in the combined operation group were significantly higher than those in the CSP group, the differences were statistically significant (P < 0.05). There were no statistically significant differences in intraoperative blood loss, hospital stay, clinical efficacy, and VAS score at 72 h after surgery between the two groups (P > 0.05). The incidence of adverse reactions was 15.00% in the combined surgery group and 5.00% in the CSP group, with no statistically significant difference (P > 0.05).Conclusion Both combination of EMR and APC scheme and CSP scheme can effectively improve the symptoms of colon polyps patients, enhance clinical efficacy, and have lower incidence of adverse reactions, with good treatment safety. However, CSP can accelerate polyp resection speed, shorten surgical time, and alleviate early postoperative pain and inflammatory cytokine levels in patients compared to combination of EMR and APC.