内镜下切除结直肠粗蒂息肉两种术式的术后出血比较

Comparison of postoperative bleeding between two endoscopic resection methods for colorectal polyps with coarse pedicle

摘要:

为比较内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）和内镜下尼龙绳或金属夹预先蒂部结扎后电切除对结直肠粗蒂息肉切除术后出血的影响，回顾性收集2018年1月至2022年11月于江苏省人民医院（南京医科大学第一附属医院）行内镜下息肉切除术患者的临床资料，根据治疗方式不同将患者分为ESD组和预先结扎组，对比分析两组患者的术后出血情况。共纳入265例患者，ESD组124例、预先结扎组141例，两组患者性别、年龄、息肉部位、息肉头部长径及息肉蒂部长径相比差异均无统计学意义（P>0.05）。ESD组术后出血率较预先结扎组低，差异有统计学意义［4.0%（5/124）比10.6%（15/141），χ2=4.126，P=0.042］；相较于ESD组，预先结扎组的出血多发生在左半结肠，差异有统计学意义［40.0%（2/5）比93.3%（14/15），P=0.032］。ESD组患者住院天数较预先结扎组长［（4.6±1.9）d比（3.4±1.5）d，t=5.641，P<0.001］。对于结直肠粗蒂息肉，ESD法较预先结扎法能够更有效减少术后出血，尤其是针对远端结肠息肉。

Abstract:

To compare the effect of endoscopic submucosal dissection (ESD) and endoscopic pedicle ligation with nylon rope or metal clip followed by electrical resection on postoperative hemorrhage for thick colorectal pedicle polyps, clinical data of patients undergoing endoscopic polypectomy in Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University) from January 2018 to November 2022 were retrospectively collected, and the patients were divided into ESD group and pre-ligation group according to different treatment methods. Postoperative bleeding data of the two groups were compared and analyzed. A total of 265 patients were included, including 124 in ESD group and 141 in pre-ligation group. There were no significant differences in gender, age, polyp sites, polyp diameter or pedicle diameter between the two groups (P>0.05). The postoperative bleeding rate in the ESD group was significantly lower than that in the pre-ligation group [4.0% (5/124) VS 10.6% (15/141), χ2=4.126, P=0.042]. Compared with ESD group, more bleeding occurred in the left colon in the pre-ligation group, with statistically significant difference [40.0% (2/5) VS 93.3% (14/15), P=0.032]. The hospital stay was longer in the ESD group than that in the pre-ligation group (4.6±1.9 days VS 3.4±1.5 days, t=5.641, P<0.001). ESD is more effective than pre-ligation in reducing postoperative hemorrhage for coarse pedicle colorectal polyps, especially for those on distal colon.