| Purpose:To evaluate the EMR and ESD early treatment of colorectal cancer and precancerous lesions of efficacy.Methods:A retrospective analysis of our hospital from January 2013 to January 2015 Affiliated Hospital of Nanjing University of Traditional Chinese Medicine (Jiangsu Provincial Hospital) digestive endoscopy center line within the next endoscopic mucosal resection (EMR) and endoscopic submucosal dissection surgery (ESD) treatment-related information early colorectal cancer and precancerous lesions. Comparative study between the two groups lesion size, hours of operation, en bloc resection rate, complete resection rate, postoperative complications, postoperative residual, recurrent and additional surgery and other related issues.Results:January 2013 to January 2015 included 168 patients with colorectal cancer and precancerous lesions as early as case studies.Research Results:January 2013 to January 2015 included 168 patients with colorectal cancer and precancerous lesions as early as case studies.Lesion size:Lesion size:EMR treated lesion diameter 6-37mm, the average diameter of 14.2±9.8mm; ESD treated lesion diameter 16-86mm, an average of 32.5±25.3mm, the difference between the two groups was statistically significant (P<0.05=0.039); lesions diameter greater than 20mm, a total of 110 cases, EMR group had 36 lesions, ESD group had 74 cases; lesion diameter less than 20mm, a total of 58 cases, EMR group had 30 lesions, ESD group had 28 cases, was no statistically significant difference (P> 0.05= 1.045).Operating time:ESD group operating time of about 33-186min around, with a median time of 69.0min; EMR group operating time 10-124min, median 25min. ESD group operating time was significantly longer than the EMR group was statistically significant (P<0.05) between the two groups. Lesions greater than 20mm, EMR group operating time 12-124min, the median time for 33min; ESD group operating time 40-186min, the median time for 94min, the two groups was statistically significant difference (P<0.05). For lesions less than 20mm, EMR group operating time for 10-70min, the median time to 20.5min; ESD group operating time 45-74min, the median time to 40.5min, the two groups was statistically significant difference (P<0.05).Enbloc resection rate:En bloc resection rate:All cases of en bloc resection rate of about 77.3%(130/168). ESD group en bloc resection rate of about 98.0%(100/102), lesion diameter 16-86mm, an average of 32.5±25.3mm, block resection rate of about 2%(1.96/102), the lesions were 70mm and 86mm, (sub 2 resection), en bloc resection and tumor size was no significant correlation (P<0.05). EMR group en bloc resection rate of about 45.4%(30/66), en bloc resection of the lesion diameter 6-25mm, the average diameter of 16.2±8.8mm; block removal rate of about 63.6%(42/66), block excision of the lesion diameter of about (18-37) mm, the average diameter of about (25.2±6.8) mm, which divided two resection 33.3 (22/66), divided 3 accounted for 11.1% removal (7/66), divided block resection associated with tumor diameter (P<0.05); en bloc resection rate of the two groups was statistically significant (P<0.05). Lesions larger than 20mm, ESD and EMR group en bloc resection rate was 97.2%(72/74) respectively, were statistically significant (P<0.05) between 13.8%(5/36); for less than 20mm lesions, ESD and en bloc resection rate of EMR group was respectively 100%(28/28),83.3% (25/30), no significant difference between the two (P> 0.05=1.45); EMR group of lesions greater than 20mm lesions and lesions less than 20mm en bloc resection rate was 13.8%(5/36) and 83.3%(25/30) respectively, the difference between the two groups was statistically significant (P<0.05=0.000). ESD group than 20mm of focal lesions and lesions less than 20mm en bloc resection rate was 97.2%(72/74) and 100%(28/28), the difference between the two groups was statistically significant (P<0.05).Complete resection rate:All patients complete resection rate was 89.2%(150/168), EMR group was 80.3%(53/66), ESD group was 98.5%(101/102), the difference between the two groups was statistically significant (P<0.05); for lesions less than 20mm of lesions, EMR group complete resection rate 93.3%(28/30), ESD group was 100%(28/28), the difference between the two groups was not statistically significant (P> 0.05), ESD and EMR group complete resection group was no significant difference; for lesions greater than 20mm of lesions, EMR complete resection rate was 69.4%(25/36),98.6%(73/74), the difference between the two groups was statistically significant (P<0.05).Complications:1) Bleeding:EMR group bleeding 4.5%(3/66), delayed postoperative hemorrhage 1.5% (1/66), no serious complications, conservative treatment. ESD group blood loss was 10.7% (11/102), delayed postoperative hemorrhage was 2.9%(3/102), less blood loss volume, postoperative hemorrhage in one case delayed by conservative invalid, turn Surgery OK intestinal repair, after a good recovery. Two blood loss and postoperative delayed bleeding were statistically significant differences (P<0.05).2) perforation:EMR group intraoperative perforation was 3.0%(2/66), postoperative delayed perforation 1.5%(1/66), no serious complications, conservative treatment. ESD group intraoperative perforation was 6.8%(7/102), postoperative delayed perforation was 1.9%(2/102), intraoperative perforation diameter are small, titanium clips can be clipped by the active anti-infection and fluid therapy may, without surgery, postoperative delayed perforation one case after conservative invalid, turn in the laparoscopic surgical repair, after a good recovery. Intraoperative and postoperative groups of delayed perforation perforation differences were statistically significant (P<0.05).Postoperative residual:168 cases of the total residue was 2.9%(5/168), EMR treatment group was 6.0%(4/66), ESD treatment group was 0.09%(1/102). The difference between the two groups was statistically significant (P<0.05).Recurrence:168 cases of total recurrence rate 4.2%(7/168), EMR treatment group was 7.5%(5/66), ESD treatment group was 1.9%(2/102), the difference between the two groups was statistically significant (P<0.05).Conclusions:1, on the whole, EMR and ESD early treatment of colorectal cancer and precancerous lesions security, economic, efficient, reliable, worthy of promotion.2, colorectal EMR and ESD operation is difficult, technically demanding. Because colorectal weak intestinal folds more towards large variation, especially the sigmoid colon, transverse colon and other straight B junction and need attention, bleeding and perforation great chance.3, the impact of EMR and ESD major complications and tumor size, location, histological type, operating time, lift the levy and so on. |
PDF Full Text Request