止血夹牙线牵引辅助技术在内镜黏膜下剥离胃角早期癌中的应用价值研究  

Efficacy of the ＂clip with the floss＂ method during endoscopic submucosal dissection for early gastric angle cancer

作　　者：王小云[1] 唐学军[1] 谈春晓[1] 彭晓斌[1] 孟淼[1] 龚镭[1] 胡臻[1] 

机构地区：[1]南京医科大学附属无锡二院消化内科,无锡214000

出　　处：《中华消化内镜杂志》2015年第12期821-824,共4页Chinese Journal of Digestive Endoscopy

基　　金：无锡市卫生局面上项目（MS201414）;无锡市卫生局资助（CSE01N1217）;适宜卫生技术推广项目（T201409）

摘　　要：目的研究止血夹牙线牵引辅助内镜黏膜下剥离术（ESD）技术在胃角早期胃癌应用的效果及对初学者的帮助价值。方法符合纳入标准27例患者，随机数字表法随机分人常规ESD组和牙线牵引组，分析ESD技术的相关指标，包括操作时间，并发症，整块切除率，完整切除率。同时，每组按时间顺序分为2个阶段，以单位时间内切割面积评价学员学习曲线的变化。结果常规ESD组整块切除率为85．7％（12／14），牙线牵引组为100．0％（13／13）。牙线牵引组操作时间明显短于常规ESD组（中位时间30min比40min，P=0．011）。2组均未发生穿孔及术后出血。在学习曲线方面，学习的第一阶段，牙线牵引组在单位时间内切割面积明显大于常规ESD组[（30±6）mm2／min比（20±5）mm2／min，P=0．01]；学习第二阶段，牙线牵引组与常规ESD组没有统计学差别（P〉0．05）。结论对于初级的ESD学者，牙线牵引辅助的ESD技术是一项安全、有效的辅助技术，尤其在胃角黏膜病变中有着较好的应用价值。Objective To investigate the therapeutic effect and safety of the ＂clip with the floss＂ method during endoscopic submucosal dissection for early gastric angle cancer. Methods A total of 27 gastric angle lesions diagnosed as early gastric cancer were treated by ESD. They were randomized to two groups, routine ESD group and ＂ clip with the floss＂ group. The procedure time, complication events, en-block resection rate and complete resection rate were compared between the two groups. Also, the learning time was divided to two stages and the learning curve was studied according to the resected specimen areas per minute. Results The en block rate was 85.7% （12/14） in the routine ESD group and 100. 0% （13/13） in the ＂clip with the floss＂ group. The procedure time in the ＂clip with the floss＂ group was significantly less than that in the routine ESD group（the median time 30 min VS 40 min,P = 0. 011 ）. Perforation and the post operative bleeding did not occur in either group. The ESD learning curving during the first learning period and the mean resected specimen （area/min） in the ＂clip with the floss＂ group were larger than routine ESD group（30 ± 6 mm2/min VS 20 ± 5 mm2/min,P = 0.01 ）. However, no difference presented during the second learning period between the two groups. Conclusion ＂Clip with the floss＂ method during endoscopic submucosal dissection for early gastric angle cancer as a novel procedure is safe, efficacious and worthy to recommend to beginning learners.

关 键 词：内镜治疗 胃肿瘤 内镜黏膜下剥离术 牵引 

分 类 号：R735.2[医药卫生—肿瘤]