The influence of three different types of hemostatic clips on wound healing and recurrence risk after EMR in early colorectal cancer
三种不同类型止血夹对结直肠早癌EMR术后创面愈合及复发风险的影响

摘要

目的 比较微创、唯德康、安杰思三种止血夹在结直肠早癌内镜下黏膜切除术术中创面处理中的应用效果。方法 纳入2022年1月至2025年9月行内镜下黏膜切除术（Endoscopic Mucosal Resection, EMR）的结直肠早癌患者360例，随机分为三组，每组120例。术后分别使用三种止血夹处理创面，比较延迟出血率、30天创面完全上皮化率及6个月局部复发率。结果 三组基线资料可比（P>0.05）。延迟出血率组间无统计学差异（P=0.25）。30天完全上皮化率：安杰思组90.8%高于微创组85.0%和唯德康组80.0%（P=0.048）。6个月复发率：安杰思组2.5%低于微创组5.1%和唯德康组8.4%（P=0.04）。多因素分析显示，分片切除、病变直径≥20mm、水平切缘阳性及止血夹类型为复发独立危险因素。结论 三种止血夹均安全有效；安杰思止血夹在促进创面愈合及降低复发风险方面优于唯德康止血夹，与微创止血夹效果相当。

Abstract

Objective Comparison of the clinical efficacy of Weichuang, Weidekang, and Anjiesi hemostatic clips for wound management during endoscopic mucosal resection of early colorectal cancer.
Methods A prospective randomized controlled trial enrolled 360 patients undergoing EMR, randomly assigned to three groups (n=120 each). Wounds were managed using corresponding clips. Outcomes included delayed bleeding rate, 30-day complete epithelialization rate, and 6-month recurrence rate.
Results Baseline characteristics were comparable. No significant difference in delayed bleeding rate (P=0.25). The 30-day complete epithelialization rate was highest in Anjies group (90.8% vs 85.0% and 80.0%, P=0.048). The 6-month recurrence rate was lowest in Anjies group (2.5% vs 5.1% and 8.4%, P=0.04). Multivariate analysis identified piecemeal resection, lesion diameter ≥20mm, positive horizontal margin, and clip type as independent risk factors for recurrence.
Conclusion   All three clips are safe and effective. Anjies clip is superior to Vedkang clip in promoting wound healing and reducing recurrence, with comparable effectiveness to Micro-Tech clip.