广西医学

目的对比水下内镜下黏膜切除术（UEMR）与常规内镜下黏膜切除术（CEMR）治疗直径6~9 mm无蒂隆起性结直肠息肉的安全性及有效性。方法回顾性分析341例行内镜切除的直径6~9 mm无蒂隆起性结直肠息肉患者的临床资料，根据手术方式分为CEMR组（218例，采用CEMR治疗）和UEMR组（123例，采用UEMR治疗）。采用倾向性得分匹配法（PSM）以1∶1比例匹配混杂因素，最终成功匹配98对患者。比较匹配后两组患者的R0切除率、完整切除率、手术时间、术中出血量、并发症（穿孔、术后腹痛）及术后复发率。结果 PSM后，UEMR组的R0切除率和完整切除率均高于CEMR组，手术时间短于CEMR组，术中出血量少于CEMR组，术后复发率低于CEMR组（P<0.05），而两组的穿孔、术后腹痛发生率差异无统计学意义（P>0.05）。结论对于直径6~9 mm的无蒂隆起性结直肠息肉，UEMR相较于CEMR具有更高的切除完整性、更短的手术时间、更少的术中出血量及更低的术后复发率，且安全性相当。

Objective To compare the safety and effectiveness of underwater endoscopic mucosal resection (UEMR) versus conventional endoscopic mucosal resection (CEMR) for treating 6-9 mm diameters sessile protruding colorectal polyps. Methods Clinical data of 341 patients with 6-9 mm diameters sessile protruding colorectal polyps who underwent endoscopic resection were retrospectively analyzed. According to the surgical methods, patients were divided into CEMR group (218 cases, treated with CEMR) or UEMR group (123 cases, treated with UEMR). Propensity score matching (PSM) was used to match confounders at a 1∶1 ratio, ultimately resulting in 98 successfully matched pairs. Post-matching comparisons were made between the two groups regarding R0 resection rate, complete resection rate, operation duration, intraoperative bleeding volume, complications (perforation, postoperative abdominal pain), and the recurrence rate. Results After PSM, the UEMR group exhibited higher R0 and complete resection rates, shorter operation duration, less intraoperative bleeding volume, and a lower recurrence rate compared to the CEMR group (P<0.05). No statistically significant difference in the incidence rates of perforation and postoperative abdominal pain was observed between the two groups (P>0.05). Conclusion For 6-9 mm diameters sessile protruding colorectal polyps, UEMR offers superior resection completeness, shorter operation duration, reduced intraoperative bleeding volume, and a lower recurrence rate compared to CEMR, while maintaining comparable safety.