内镜黏膜冷切除术和热切除术在结直肠6~10 mm无蒂息肉治疗中的疗效对比

目的：探讨黏膜下注射后内镜黏膜冷切除术和黏膜热切除术在治疗结直肠直径6~10 mm无蒂息肉中的疗效。方法：选取2016年1月至2017年6月江阴市中医院收治的因结直肠无蒂息肉（6~10 mm）拟行内镜切除的110例患者，共131枚息肉，随机分为冷切除组和热切除组。所有患者均于术中采用靛胭脂、生理盐水混合液进行黏膜下注射。分析2组患者病变完整切除率、手术时间、手术相关并发症发生率（包括术中出血或穿孔及术后1个月内迟发性出血或穿孔）及术后半年内息肉残留或复发率。结果：冷切除组55例患者，共62枚息肉，热切除组55例，共69枚息肉。2组息肉大小、位置、内镜形态和病理类型差异无统计学意义。冷切除组平均手术时间较热切除组明显缩短（2.2±1.1）min vs（3.6±1.4）min，P<0.001]。冷切除组息肉完整切除率为95.2%，热切除组息肉完整切除率为91.3%，差异无统计学意义（P=0.599）。冷切除组术中出血1例，术后出血1例；热切除组术中出血2例，术中穿孔1例，术后出血1例，2组并发症差别无统计学意义（P=0.675）。术后半年复查肠镜，无息肉残留或复发。结论：黏膜下注射后内镜黏膜冷切除术是传统冷切除术的有效改良，可作为结直肠6~10 mm无蒂息肉的有效切除方式。

Comparison of endoscopic mucosal cold and hot snare resection in the treatment of 6-10 mm sessile colorectal polyps

Objective: To explore endoscopic mucosal resection using cold snare (CS-EMR) versus hot snare (HS-EMR) for 6-10 mm sessile colorectal polyps.Methods: From January, 2016 to June, 2017, 110 patients who were treated in Jiangyin Hospital of traditional Chinese medicine with 131 polyps were consecutively included and randomly assigned to two groups: CS-EMR and HS-EMR groups. Submucosal injection with normal saline mixed with methylene blue was performed in both groups. To analyze the rate of complete resection, procedure time, adverse events including intraoperative bleeding or perforation, postoperative bleeding within one month, as well as the incidence of polyp residue or recurrence within six months.Results: CS-EMR group included 55 patients with 62 polyps and HS-EMR group included 55 patients with 69 polyps. There was no significant difference in the size, location, morphology, or pathology of the polyps. The rates of complete resection in CS-EMR and HS-EMR were 95.2% and 91.3%, respectively (P=0.60). The operation time of the CS-EMR group was shorter than that of the HS-EMR group (2.2±1.1]min vs3.6±1.4] min, P<0.01). In the CS-EMR group, there was 1 case of intraoperative bleeding and 1 case of delayed bleeding; in HS-EMR group, there were 2 cases of intraoperative bleeding, 1 case of intraoperative perforation, and 1 case of delayed bleeding. There was no difference in the adverse event rate (P=0.68). Repeat colonoscopy in 6 months showed no polyp residual or recurrence.Conclusion: CS-EMR appears to be a valuable modification of the standard cold snare technique for the treatment of 6-10 mm sessile colorectal polyps.