冷陷多斑切除与热内镜粘膜切除用于大型非形结直肠多斑:随机对照试验的系统审查和元分析
Andrea Sorge1,2, Michele Montori2,3, Maria Eva Argenziano2,3,4
1Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Endoscopy
|March 18, 2025
概括
冷陷多角切除术 (CSP) 的复发风险高于热内镜粘膜切除术 (H-EMR) 对于大型非杆结直肠多瘤 (LNPCPs). 然而,CSP提供了显著降低延迟出血的风险,使其成为某些患者更安全的选择.
科学领域:
- 胃肠病学 胃肠病学
- 内镜手术 进行内镜手术
- 结肠直肠癌 预防 预防
背景情况:
- 大型非形结肠直肠多 (LNPCPs) 构成了内镜切除的挑战.
- 冷陷多角切除术 (CSP) 和热内镜粘膜切除术 (H-EMR) 是常见的技术.
- 对于LNPCP,CSP和H-EMR之间的复发和不良事件 (AE) 的比较数据至关重要.
研究的目的:
- 为了比较CSP和H-EMR之间的聚复发和不良事件 (AE) 的风险.
- 评估这些技术对LNPCP≥15mm.的安全性和有效性.
主要方法:
- 四个随机对照试验 (RCT) 的元分析,涉及1516个LNPCP.
- 在Medline,Embase和Cochrane图书馆数据库中进行系统的文献搜索,直到2024年8月.
- 随机效应模型用于计算复发和AEs的聚合风险比率 (RRs).
主要成果:
- 与H-EMR相比,CSP的复发风险几乎是双倍的 (22.6%与10.8%相比;RR 1.98;P=0.02).
- CSP显著降低了67% (1.2%对3.9%;RR 0.33;P=0.03) 的延迟出血的风险.
- 没有观察到CSP的手术内或延迟穿孔;手术内出血风险没有显著差异.
结论:
- CSP与LNPCP的复发风险更高相关,但在延迟出血方面提供了更高的安全性.
- 对于那些优先考虑程序安全而不是完全激进的患者来说,CSP可能更好,例如那些患有并发症的患者.
- 进一步的研究可能会探索在LNPCP管理中使用CSP减轻复发风险的策略.
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