注水法圈套器冷切除术在治疗结肠无蒂锯齿状病变中的应用

Application of underwater cold snare polypectomy in the treatment of sessile serrated lesions in the colon

摘要:

目的 通过评估黏膜肌层完整率及黏膜下层深度，比较不同内镜切除方法切除直径6～10 mm的结肠无蒂锯齿状病变（SSL）的有效性及安全性。方法 纳入2024年1月－2025年6月该院收治的结肠SSL患者160例（共162枚病变），按照随机数表法分为圈套器冷切除术（CSP）组、注水法圈套器冷切除术（UCSP）组、注水法内镜黏膜切除术（UEMR）组和传统内镜黏膜切除术（CEMR）组，比较4组患者黏膜肌层完整率、黏膜下层深度、R0切除率、手术时间、不良事件和手术费用。结果 CSP组黏膜肌层完整率明显低于其他3组，黏膜下层深度明显浅于其他3组，差异均有统计学意义（P < 0.05）；UCSP组、UEMR组和CEMR组黏膜肌层完整率比较，差异无统学意义（P > 0.05）；CEMR组术后病理提示，黏膜下层深度最深，与UEMR组比较，差异无统计学意义（P > 0.05），但明显深于UCSP组和CSP组，差异均有统计学意义（P < 0.05），而UCSP组与UEMR组黏膜下层深度比较，差异无统计学意义（P > 0.05）。4组患者R0切除率比较，差异无统计学意义（P > 0.05）。CEMR组手术时间为（187.7±61.5）s，明显长于其他3组，差异有统计学意义（P < 0.05），其他3组间手术时间比较，差异无统计学意义（P > 0.05）。UEMR组和CEMR组手术费用明显多于CSP组和UCSP组，差异有统计学意义（P < 0.05）。4组患者均未出现穿孔，4组患者瞬时出血和迟发性出血比较，差异均无统计学意义（P > 0.05）。结论 注水和黏膜下注射治疗结肠SSL，有助于提高黏膜肌层切除率，利于更深层的黏膜下层切除，综合考虑手术时间和手术费用，针对此类病变建议选择UCSP，其更适合在基层医院推广。

Abstract:

Objective To compare the effectiveness and safety of different endoscopic methods for removing colonic sessile serrated lesions (SSL) with a diameter of 6~10 mm by evaluating the rate of complete muscularis mucosae resection and the resection depth of the submucosa tissue.Methods 160 patients with 162 colonic SSL admitted to our hospital from January 2024 to June 2025 were selected as the research subjects. They were randomly divided into cold snare polypectomy (CSP) group, underwater cold snare polypectomy (UCSP) group, underwater endoscopic mucosal resection (UEMR) group, and conventional endoscopic mucosal resection (CEMR) group by random number table. The integrity rate of the mucosal muscular layer, submucosal depth, R0 resection rate, operation time, adverse events and operation cost were compared in four groups.Result The integrity rate of the mucosal muscular layer in the CSP group was significantly lower than that in the other three groups, and the depth of the submucosa was significantly shallower than that in the other three groups. The differences were statistically significant (P < 0.05). There was no statistically significant difference in the integrity rate of the mucosal muscular layer among the UCSP group, the UEMR group and the CEMR group (P > 0.05). The postoperative pathology of the CEMR group indicated that the depth of the submucosa was the deepest, and there was no statistically significant difference compared with the UEMR group (P > 0.05), but it was significantly deeper than that of the UCSP group and CSP group, and the difference was statistically significant (P < 0.05). When comparing the depth of the submucosa between the UCSP group and the UEMR group, there was no statistically significant difference (P > 0.05). There was no statistically significant difference in the R0 resection rate in the four groups of patients (P > 0.05). The operation time of the CEMR group was (187.7 ± 61.5) s, which was significantly longer than that of the other three groups, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the operation time among the other three groups (P > 0.05). The surgical costs of the UEMR and CEMR groups was significantly higher than those of the CSP group and the UCSP group, and the difference was statistically significant (P < 0.05). No adverse events such as perforation occurred in the four groups of patients. There were no statistically significant differences in transient and delayed bleeding in the four groups of patients (P > 0.05).Conclusion Water injection and submucosal injection for the treatment of colon SSL can help increase the resection rate of the muscularis mucosa and achieve deeper submucosal resection. Considering the operation time and cost comprehensively, UCSP is recommended for such lesions, as it is more suitable for promotion in primary hospitals.