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目的探讨EMR、内镜下粘膜剥离术(ESD)联合内镜下粘膜切除术(EMR)和单独ESD治疗结直肠隆起性病变的应用价值。方法回顾性分析2011年12月至2014年12月进行的36例EMR、34例ESD联合EMR及28例单独ESD治疗结直肠隆起性病变患者,分析比较两组之间的手术耗时、整块切除率,术中术后出血、穿孔发生率及局部残留复发率。结果 EMR组手术时间明显缩短,ESD联合EMR组的手术时间与单独ESD组无显著差异,分别为19、26.4、28.8分钟。三组的整块切除率(72.2%、94.1%、100%);三组的术中出血率(30.6%、17.6%、21.4%);三组的穿孔发生率(11.1%、0%、7.14%);局部残留及复发率(16.7%、5.9%、3.57%)。结论 ESD联合EMR和单独ESD治疗结直肠隆起性病变的疗效及并发症发生率相当,而EMR组的整块切除率,局部残留复发率,术中出血率明显高于另外两组。ESD联合EMR可以简化操作,在治疗结直肠隆起性病变时能明显缩短手术时间,可做为ESD初学者的入门技术。
Objective To investigate the value of EMR, endoscopic mucosal dissection (ESD) combined with endoscopic mucosal resection (EMR) and single ESD in the treatment of colorectal protuberant lesions. Methods A retrospective analysis of 36 patients with EMR, 34 patients with ESD combined with EMR and 28 patients with ESD alone treated from December 2011 to December 2014 were performed. The operative time, Resection rate, intraoperative and postoperative bleeding, the incidence of perforation and local residual recurrence rate. Results The operation time of EMR group was significantly shortened. There was no significant difference between the EMR group and the ESD group (19, 26.4, 28.8 minutes). The resection rates of the three groups were 72.2%, 94.1% and 100% respectively. The intraoperative bleeding rates were 30.6%, 17.6% and 21.4% in the three groups. The incidence of perforation in the three groups was 11.1%, 0% and 7.14 %); Local residual and recurrence rate (16.7%, 5.9%, 3.57%). Conclusions Efficacy and complication rate of ESD combined with EMR and ESD alone are similar in patients with colorectal protuberant lesions. However, the resection rate, residual residual disease rate and intraoperative bleeding rate in EMR group were significantly higher than those in the other two groups. The combination of ESD and EMR simplifies operation and significantly reduces the time required to treat colic elevated lesions as a starting point for ESD beginners.