锚定内镜黏膜切除术在治疗结直肠无蒂息肉中的应用价值

Application value of anchoring endoscopic mucosal resection for the treatment of colorectal sessile polyps

摘要:

目的 探讨锚定内镜黏膜切除术（anchoring endoscopic mucosal resection，A‑EMR）的安全性与优势。方法 纳入2024年1月至9月在南方医科大学第十附属医院行结直肠息肉切除的患者进行随机对照研究，病变均为无蒂息肉，长径10~20 mm。使用随机数字表法分为两组，分别为A‑EMR组与常规内镜黏膜切除术（conventional endoscopic mucosal resection，C‑EMR）组。评估两组患者基线资料，分别记录操作时间、术中及术后并发症，并对比整块切除率及完全切除率。结果 A‑EMR组纳入56例患者（58枚息肉），C‑EMR组纳入54例患者（55枚息肉），两组患者基线资料差异无统计学意义（P>0.05）。A‑EMR组切除时间略短于C‑EMR组［（4.48±0.50）min比（5.17±0.71）min］，差异无统计学意义（t=-1.590，P=0.115）；两组间术中和术后总出血率比较［7.1%（4/56）比13.0%（7/54）］，差异亦无统计学意义（χ2=1.035，P=0.309）。A‑EMR组和C‑EMR组整块切除率［96.6%（56/58）比81.8%（45/55）］及完全切除率［93.1%（54/58）比74.5%（41/55）］比较，差异有统计学意义（χ2=6.456，P=0.011；χ2=7.260，P=0.007）。结论 A‑EMR在结直肠无蒂息肉切除中安全可靠，优势明显，值得临床推广。

Abstract:

Objective To evaluate the safety and efficacy of anchoring endoscopic mucosal resection (A‑EMR) for the treatment of colorectal sessile polyps. Methods Patients with 10‑20 mm colorectal sessile polyps at the Tenth Affiliated Hospital, Southern Medical University from January to September 2024 were included in a randomized controlled trial and randomized to A‑EMR or conventional EMR (C‑EMR) group using the random number table method. Baseline data, operation time, intraoperative and postoperative complications, the en bloc resection rate, and complete resection rate were compared between the two groups. Results A total of 56 patients (58 polyps) underwent A‑EMR and 54 patients (55 polyps) C‑EMR, with comparable baseline characteristics (P>0.05). Resection time was similar between the two groups (4.48±0.50 min VS 5.17±0.71 min, t=-1.590, P=0.115). The overall rates of intraoperative and postoperative bleeding were similar between the two groups [7.1% (4/56) VS 13.0% (7/54), χ2=1.035,P=0.309)]. The A‑EMR group demonstrated significantly higher en bloc resection [96.6% (56/58) VS 81.8% (45/55)] and complete resection rates [93.1% (54/58) VS 74.5% (41/55)] compared with the C‑EMR group (χ2=6.456, P=0.011; χ2=7.260, P=0.007). Conclusion A‑EMR is safe and reliable for the resection of colorectal sessile polyps , demonstrating superior resection outcomes compared with C-EMR.