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内镜下黏膜切除术和内镜下黏膜下剥离术对结肠息肉切除的影响及复发相关因素

The Impact of Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection on Colonic Polyp Resection and Factors Influencing Recurrence.

作者信息

Li Binnan, Zheng Wanqiong

机构信息

Department of General Surgery, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou, China.

出版信息

Surg Laparosc Endosc Percutan Tech. 2024 Dec 1;34(6):607-613. doi: 10.1097/SLE.0000000000001329.

Abstract

OBJECTIVE

This study aims to assess the effectiveness of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the endoscopic resection of colonic polyps and investigate the factors influencing polyp recurrence.

METHODS

A total of 174 patients with colorectal polyps admitted to the Gastroenterology Department during the same period were included in this prospective randomized controlled study. The patients were randomly allocated to the EMR group and ESD group (72 cases in each group) using a random number table. The clinical efficacy, quality of life, adverse reactions, and 1-year postoperative recurrence rate were compared between the 2 groups. In addition, factors influencing polyp recurrence were analyzed.

RESULTS

No significant differences were observed between the EMR and ESD groups in terms of clinical efficacy, postoperative quality of life, and postoperative complications. However, the postoperative recurrence rate in the ESD group was significantly lower than that in the EMR group. Multifactorial logistic regression analysis revealed that the number of polyps ≥3, maximum polyp diameter ≥2 cm, and family history of colorectal cancer were independent risk factors for colonic polyp recurrence.

CONCLUSION

ESD and EMR demonstrate similar efficacy and safety in patients with colonic polyps. However, the recurrence rate after ESD is significantly lower than after EMR. Furthermore, multifactorial analysis indicates that a larger polyp diameter, a more significant number of polyps, and a family history of colorectal cancer are independent risk factors for the recurrence of colonic polyps following resection.

摘要

目的

本研究旨在评估内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)在结肠息肉内镜切除术中的有效性,并探讨影响息肉复发的因素。

方法

本前瞻性随机对照研究纳入同期收治于消化内科的174例结直肠息肉患者。采用随机数字表法将患者随机分为EMR组和ESD组(每组72例)。比较两组的临床疗效、生活质量、不良反应及术后1年复发率。此外,分析影响息肉复发的因素。

结果

EMR组和ESD组在临床疗效、术后生活质量及术后并发症方面均无显著差异。然而,ESD组的术后复发率显著低于EMR组。多因素logistic回归分析显示,息肉数量≥3个、最大息肉直径≥2 cm以及结直肠癌家族史是结肠息肉复发的独立危险因素。

结论

ESD和EMR在结肠息肉患者中显示出相似的疗效和安全性。然而,ESD术后的复发率显著低于EMR术后。此外,多因素分析表明,较大的息肉直径、较多的息肉数量以及结直肠癌家族史是结肠息肉切除术后复发的独立危险因素。

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