内镜下黏膜切除术与黏膜剥离术治疗早期结直肠癌的疗效及安全性比较分析

目的 比较内镜下黏膜切除术(EMR)与内镜下黏膜剥离术(ESD)治疗早期结直肠癌的临床疗效及安全性.方法 选取早期结直肠癌患者91例,其中42例患者接受EMR治疗(EMR组),49例患者接受ESD治疗(ESD组).比较两组患者的手术时间、不同直径病灶完全切除率和整块切除率、并发症发生率、术后复发率和残留率.结果 EMR组的总体手术时间、病灶直径≥2.0 cm患者和<2.0 cm患者的手术时间均短于对照组,并发症发生率低于ESD组(P<0.05);ESD组直径≥2.0 cm病灶的完全切除率和整块切除率均明显高于EMR组(P<0.05);EMR组的术后复发率和残留率均明显高于ESD组(P<0.05).结论 对于早期结直肠癌病灶直径≥2.0 cm的患者,ESD治疗效果更好,但其对手术操作要求较高,且存在并发症发生率较高的风险,临床需根据患者实际情况选择不同术式.

Comparison of efficacy and safety between endoscopic mucosal resection and submucosal dissection for treatment of early colorectal cancer

Objective To compare the clinical efficacy and safety between endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) for the treatment of early colorectal cancer.Methods Ninety-one patients with early colorectal cancer were enrolled,including 42 patients treated by EMR(EMR group) and 49 patients treated with ESD(ESD group).The operation duration,total resection rate and en bloc resection rate of lesions with different diameters,incidence rate of complications,postoperative recurrence rate and residual rate were compared between the two groups.Results The total operation duration,operation duration of the patients with lesion diameter ≥2.0 cm or <2.0 cm,and incidence rate of complications of the EMR group were significantly less or lower than those of the ESD group(P<0.05).The total resection rate and en bloc resection rate of lesions with diameter ≥2.0 cm were significantly higher in the ESD group compared to the EMR group(P<0.05).The postoperative recurrence rate and residual rate of the EMR group were significantly higher than those of the ESD group(P<0.05).Conclusion For the early colorectal cancer patients with lesion diameter ≥2.0 cm,ESD obtains better efficacy.However,ESD has a higher requirement on the operative procedure and a risk of higher incidence rate of complications.Different operative approaches should be chosen according to the practical situation of patients clinically.