Study On The Efficacy And Safety Of Different Submucosal Injection In ESD For Pre-hemostatic Management Of Patients With Early Colorectal Cancer And Precancerous Lesions

Objective: To observe the effect of different submucosal injection in endoscopic submucosal dissection(ESD)on the efficacy and safety of pre-hemostatic management in patients with early colorectal cancer and precancerous lesions Methods:A total of 80 patients with early colorectal cancer and precancerous lesions who underwent ESD surgery in the First Affiliated Hospital of China Medical University from June 2018 to October 2020 were collected.According to the different intraoperative application of submucosal injection(hemagglutinase + methylene blue + normal saline group,adrenaline + methylene blue + normal saline group),they were divided into 2groups for pre-hemostasis management,with 40 cases in each group.The relevant data before,during and after 3 days were recorded respectively.Results: Compared with the epinephrenaline group,intraoperative hemoglobinase group showed decreased unit blood loss,percentage of patients with additional endoscopic hemostasis,and increased surgical speed(P < 0.05),but there was no statistical difference in hemostasis speed and additional times of hemostasis under endoscopy.(P >0.05).The effect on heart rate and blood pressure were decreased(P < 0.05).Three days after the operation,the hemocoagulase group had less adverse reactions of dizziness,confusion,allergic reactions,vomiting(P < 0.05),less postoperative hemostatic drugs and endoscopic hemostasis(P < 0.05),and there was no statistical significance in other adverse reactions(P > 0.05).There was no significant difference in delayed hemostasis effect between the two groups on postoperative 3 days(P > 0.05).Multivariate Logistic regression analysis showed that the amount of intraoperative blood loss in this study was an independent risk factor for delayed bleeding 3 days after surgery(P=0.035,OR=1.01995%CI: 1.001-1.037)in patients with early colorectal cancer and precancerous lesions treated by ESD,and had nothing to do with the types of drugs used for intraoperative pre-hemostasis management and other intraoperative factors.Conclusion: Compared with the intraoperative administration of epinephrine in the treatment of early colorectal cancer and precancerous lesions with endoscopic sub mucosal dissection,the effect and postoperative safety of intraoperative pre-hemost asis management with haemocoagulase were better,but there was no significant difference in the prevention of postoperative delayed bleeding.