采用环形切口的内镜黏膜切除术切除结肠肿瘤。随机试验结果。

E. U. Abdulzhalieva, A. Likutov, V. Veselov, D. Mtvralashvili, O. M. Yugai, E. Khomyakov, S. Chernyshov, O. Sushkov
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引用次数: 0

摘要

目的:比较环形切口内镜下粘膜切除术(C-EMR)和内镜下粘膜下剥离术(ESD)在治疗结肠大面积良性上皮肿瘤患者中的近期和远期效果。结果:与ESD方法相比,C-EMR方法切除肿瘤所需的时间明显更短,分别为30分钟和60分钟(P<0.001)。C-EMR 组有 13(23.7%)名患者出现术中和术后并发症,ESD 组有 12(23.5%)名患者出现术中和术后并发症。主要组和对照组最常见的并发症是术后凝血综合征,分别为 9 例(17.3%)和 11 例(21.6%)。研究发现,肿瘤位置困难(OR=18.3;P=0.01)和术中并发症(OR=37.5;P=0.04)是内镜介入的独立转换因素。主治组和对照组的肿瘤全切率和切除边缘阴性率(R0)没有显著差异,分别为47(90.4%)和49(96.1%)(P=0.4)以及40(76.9%)和45(88.2%)(P=0.2)。结论:内镜下粘膜环切术是一种有效、安全的手术,其效果可与内镜下粘膜下剥离术媲美,可作为治疗大小为 20 至 30 毫米的结肠良性上皮瘤的首选方法。此外,使用 C-EMR 方法的手术时间是使用 ESD 方法的两倍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endoscopic mucosal resection with a circumferential incision in the removal of colon neoplasms. Results of a randomized trial.
OBJECTIVE: to compare the immediate and long-term results of endoscopic mucosal resection with a circular incision (C-EMR) and endoscopic submucosal dissection (ESD) in the treatment of patients with large benign epithelial neoplasms of the colon.PATIENTS AND METHODS: a prospective randomized comparative study was conducted from November 2020 to July 2022, included 103 patients with benign epithelial neoplasms of the colon ranging in size from 20 to 30 mm. The C-EMR method was used in 52, ESD - 51 patients.RESULTS: the removal of the tumor by the C-EMR method required statistically significantly less time, compared with the ESD method – 30 and 60 minutes, respectively (p<0.001). Intra- and postoperative complications occurred in 13(23.7%) patients in the C-EMR group and in 12(23.5%) patients in the ESD group. The most frequently reported complication was postcoagulation syndrome in the main and control groups – in 9(17.3%) and 11(21.6%) cases, respectively. It was found that the difficult location of the tumor (OR=18.3; p=0.01) and intraoperative complications (OR =37.5; p=0.04) are independent conversion factors of endoscopic intervention. The frequency of tumor removal in a en bloc and achievement of negative resection margins (R0) in the main and control groups did not significantly differ – 47(90.4%) and 49(96.1%) (p=0.4) and 40(76.9%) and 45(88.2%) (p=0.2), respectively.CONCLUSION: endoscopic mucosal resection with a circumferential incision is an effective and safe operation comparable to endoscopic submucosal dissection, and can be the method of choice for benign epithelial neoplasms of the colon with sizes from 20 to 30 mm. In addition, the duration of the operation using the C-EMR method is two times less than using ESD.
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