内镜下电凝切除术与冷切除技术治疗老年复杂性结肠息肉的临床研究

Clinical study of endoscopic electrocoagulation resection versus cold resection for the treatment of complex colonic polyps in elderly patients

摘要:

目的 探讨内镜下电凝切除术与冷切除技术治疗老年复杂性结肠息肉的临床疗效。方法 回顾性分析2021年8月－2023年8月于该院消化内科行内镜下结肠息肉电凝切除和冷切除治疗的100例老年结肠息肉患者的临床资料。根据手术方式的不同，将患者分为电凝组（50例）和冷切组（50例）。统计两组老年结肠息肉患者的息肉切除情况、术中及术后治疗情况、术后疼痛程度、胃肠道生活质量指数（GIQLI）评分、住院时间、治疗总费用，以及随访1年后的复发情况。结果 电凝组共切除息肉108枚，冷切组共切除息肉113枚，冷切组息肉完整切除率高于电凝组，标本受损率低于电凝组，差异均有统计学意义（P < 0.05）；两组患者平均息肉切除数量和标本回收率比较，差异均无统计学意义（P > 0.05）。冷切组手术时间和住院时间短于电凝组，治疗总费用少于电凝组，术中钛夹使用率低于电凝组，差异均有统计学意义（P < 0.05）。电凝组术中出血、迟发出血、穿孔和腹痛发生率分别为6.00%、2.00%、2.00%和6.00%，高于冷切组的2.00%、0.00%、0.00%和2.00%，两组患者并发症总发生率比较，差异有统计学意义（P < 0.05）。冷切组术后24和48 h的视觉模拟评分法（VAS）评分低于电凝组，差异均有统计学意义（P < 0.05）。冷切组术后3个月的GIQLI评分高于电凝组，差异有统计学意义（P < 0.05）。冷切组术后1年的复发率低于电凝组，但两组患者比较，差异无统计学意义（P > 0.05）。结论 内镜下冷切除技术治疗老年复杂性结肠息肉患者，临床疗效较电凝切除术好，且安全性高，治疗费用少。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of endoscopic electrocoagulation resection and cold resection techniques in the treatment of elderly patients with complex colonic polyps.Methods A retrospective selection was made of 100 elderly patients with colonic polyps who underwent endoscopic electrocoagulation resection and cold resection of colonic polyps in the Department of Gastroenterology of Yiwu Central Hospital from August 2021 to August 2023. According to the different surgical methods, the patients were divided into the electrocoagulation group (50 cases) and the cold resection group (50 cases). The polyp resection status, intraoperative and postoperative treatment conditions, postoperative pain degree, gastrointestinal quality of life index (GIQLI) score, length of hospital stay, total treatment cost, and recurrence situation after 1-year follow-up of the elderly patients with colonic polyps in the two groups were statistically analyzed.Results 108 polyps were resected in the electrocoagulation group and 113 in the cold resection group. The complete resection rate of polyps in the cold resection group was higher than that in the electrocoagulation group, the specimen damage rate was lower than that in the electrocoagulation group, the differences were statistically significant (P < 0.05). There were no statistically significant difference in the average number of polyps removed and the recovery rate of polyp specimens between the two groups (P > 0.05). The operation time and hospital stay of the cold resection group were shorter than those of the electrocoagulation group, the total treatment cost was less than that of the electrocoagulation group, and the usage rate of titanium clips during the operation was lower than that of the electrocoagulation group. The differences were all statistically significant (P < 0.05). The incidences of intraoperative bleeding, delayed bleeding, perforation and abdominal pain in the electrocoagulation group were 6.00%, 2.00%, 2.00% and 6.00% respectively, which were higher than those in the cold resection group (2.00%, 0.00%, 0.00% and 2.00%), and there was statistically significant difference in the total incidence of complications between the two groups of patients (P < 0.05). The visual analogue scale (VAS) scores of the cold resection group at 24 and 48 h after surgery were lower than those of the electrocoagulation group, and the differences were statistically significant (P < 0.05). The GIQLI score of the cold resection group 3 months after the operation was higher than that of the electrocoagulation group, and the difference was statistically significant (P < 0.05). The recurrence rate of the cold resection group at 1 year was lower than that of the electrocoagulation group, but the difference was not statistically significant (P > 0.05).Conclusion The clinical efficacy of endoscopic cold resection technique in the treatment of elderly complex colonic polyps patients is better than that of electrocoagulation resection, and it has high safety and low treatment cost. It is worthy of clinical promotion and application.