Abstract:

Objective　To observe the application value of triamcinolone acetonide pretreatment assisted with endoscopic submucosal dissection (ESD) in the treatment of colorectal cancer and its prevention and treatment effect on intestinal stenosis. Methods　This was a prospective randomized controlled trial. This study selected 120 colorectal cancer patients admitted to Henan University Huaihe Hospital between June 2020 and October 2022 as the study subjects. By using the random number table method, 50 patients who only received ESD were included in the control group, and 70 patients who received triamcinolone acetonide pretreatment as an auxiliary ESD treatment were included in the observation group. In the control group, there were 30 males and 20 females, aged (65.25±5.31) years; in the observation group, there were 42 males and 28 females, aged (66.16±5.28) years. All patients were followed up for 6 months to compare the treatment status, postoperative complications, postoperative intestinal stenosis, postoperative recovery, and occurrence of adverse reactions between the two groups. Independent sample t test, χ² test, and rank sum test were used. Results　Under different treatment plans, the operation time of the observation group was (61.15±10.27) minutes, and there was no statistically significant difference compared to that of the control group [(58.44±10.26) minutes] (P>0.05). The number of repeated expansions in the observation group was (1.44±0.27), which was lower than that in the control group [(3.35±1.02)], and the interval between expansions in the observation group was (20.33±8.26) weeks, which was longer than that in the control group [(14.15±5.41) weeks], with statistically significant differences (t=14.972 and 4.626, both P<0.001). After treatment, the incidence of postoperative complications in the observation group was 7.14% (5/70), and the incidence of intestinal stenosis was 7.14% (5/70), which were both lower than those in the control group [20.00% (10/50) and 22.00% (11/50)], with statistically significant differences (χ²=7.050, P=0.008; Z=-2.360, P=0.018). After treatment, the excellent and good recovery rate of dysphagia in the observation group was 91.43% (64/70), higher than that in the control group [76.00% (38/50)], with a statistically significant difference (χ²=8.732, P=0.003). The incidence of adverse reactions in the observation group was 13.33% (4/70), and there was no statistically significant difference compared to that in the control group [6.00% (3/50)] (P>0.05). Conclusions　The use of triamcinolone acetonide pretreatment combined with ESD treatment can enhance the surgical efficacy, reduce the risk of repeated expansions, complications, and intestinal stenosis, and promote the postoperative recovery of dysphagia symptoms in patients. Triamcinolone acetonide is safe and does not significantly increase the risk of adverse reactions in patients.

Key words:

Colorectal cancer, Endoscopic submucosal dissection, Triamcinolone acetonide, Intestinal stenosis, Dysphagia

摘要：

目的　观察曲安奈德预处理辅助内镜黏膜下剥离术（ESD）治疗结直肠癌的应用价值及对肠道狭窄的防治效果。方法　本文为前瞻性随机对照试验。本次研究以河南大学淮河医院2020年6月至2022年10月期间收治的120例结直肠癌患者作为研究对象，采用计算机随机数字表法分组。对照组50例患者，其中男30例，女20例，年龄（65.25±5.31）岁，仅接受ESD治疗；观察组70例患者，其中男42例，女28例，年龄（66.16±5.28）岁，采用曲安奈德预处理辅助ESD治疗。两组术后均开展为期6个月的短期随访。比较两组患者治疗情况、术后恢复情况，比较术后并发症、肠道狭窄、不良反应的发生情况。采用独立样本t检验、χ²检验、秩和检验。结果　在不同治疗方案下，观察组的手术耗时为（61.15±10.27）min，对照组为（58.44±10.26）min，差异无统计学意义（P>0.05）；观察组的重复扩张次数少于对照组［（1.44±0.27）次比（3.35±1.02）次］、扩张间隔时间长于对照组［（20.33±8.26）周比（14.15±5.41）周］，差异均有统计学意义（t=14.972、4.626，均P<0.001）。治疗后，观察组的术后并发症总发生率为7.14%（5/70），肠道狭窄总发生率为7.14%（5/70），均低于对照组［20.00%（10/50）、22.00%（11/50）］，差异均有统计学意义（χ²=7.050，P=0.008；Z=-2.360，P=0.018）；观察组的吞咽困难恢复优良率高于对照组［91.43%（64/70）比76.00%（38/50）］，差异有统计学意义（χ²=8.732，P=0.003）。观察组不良反应总发生率为13.33%（4/70），对照组为6.00%（3/50），差异无统计学意义（P>0.05）。结论　采用曲安奈德预处理辅助ESD治疗能增强手术疗效，对减少重复扩张、降低并发症及肠道狭窄发生风险，促进术后吞咽困难症状恢复均有积极意义；曲安奈德安全性高，未明显增加患者不良反应发生风险。

关键词:

结直肠癌, 内镜黏膜下剥离术, 曲安奈德, 肠道狭窄, 吞咽困难