带线钛夹在胃异位胰腺内镜黏膜下剥离术中的应用价值  

Application of clip traction to endoscopic submucosal dissection for heterotopic pancreas in stomach

作　　者：唐悦 谢霞[2] 陶杨[1] 于劲[2] 樊超强[2] 柏健鹰[2] 

机构地区：[1]广州中医药大学附属重庆北碚中医院消化科,重庆400700 [2]第三军医大学新桥医院消化科

出　　处：《中华消化内镜杂志》2017年第3期190-193,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价带线钛夹辅助牵引技术在胃异位胰腺内镜黏膜下剥离术（ESD）治疗中的使用效果和安全性。方法2013年5月至2016年2月，在第三军医大学新桥医院消化内科行ESD治疗，且术后病理确诊的62例胃异位胰腺（均为单发黏膜下来源）患者的病例资料纳入回顾性分析，对比分析使用带线钛夹辅助牵引技术组（观察组，n=36）和传统ESD组（对照组，n=26）的剥离时间、剥离过程中黏膜下层的暴露情况、并发症发生情况及随访结果。结果62例均成功施行ESD治疗。剥离时间观察组明显短于对照组[（19．35±10．34）min比（27．02±14．27）min，t＇=2．333，P=0．023]。并且剥离过程中黏膜下层的暴露效果观察组优于对照组。出血发生率观察组为55．6％（20／36），对照组为61．5％（16／26），组间差异无统计学意义（x2=0．222，P=0．638）。观察组无一例发生穿孔，对照组发生1例（3．8％，1／26），组间差异无统计学意义（P=0．419）。随访期间，62例均无复发。结论ESD治疗胃异位胰腺安全有效，剥离过程中使用带线钛夹辅助牵引技术可有效缩短手术时间，并且有利于减少手术相关并发症的发生。Objective To evaluate the efficacy and safety of clip traction in endoscopic submucosal dissection （ESD） for heterotopic pancreas in stomach. Methods Data of 62 patients with pathologically confirmed heterotopic pancreas treated by ESD between May 2013 and February 2016 were retrospectively studied in Department of Gastroenterology of X!nqiao Hospital, whose lesions were single and origins were submucosal. Thirty-six cases underwent ESD with clip traction （clip group, n= 36）, and 26 cases underwent ESD without clip traction （ non-clip group, n = 26）. The procedure time, visualization of the submucosal during dissection, complications and the result of follow-up were evaluated between the two groups. Results ESD was successful in all cases. The procedure time was significantly shorter in the clip group than in the non-clip group （ 19. 35±10. 34 min VS 27. 02± 14. 27 min, t＇ = 2. 333, P = 0. 023 ） , and good visualization was obtained by applying clip traction. The rate of bleeding in the clip group was 55.6% （20/36）, and that in the non-clip group was 61.5% （16/26）.There was no significant difference between the two groups （X2= 0. 222, P= 0. 638）. Moreover, perforation did not occur in the clip group, but occurred in one patient in the non-clip group（ 3.8%, 1/26）. There was no significant difference between the two groups（ P = 0. 419）. All patients were followed up, there was no recurrence. Conclusion ESD is effective and safe for heterotopic pancreas in stomach. Clip traction can shorten the operation time and reduce complications of ESD.

关 键 词：内窥镜 异位 胰腺 辅助 牵引力 内镜黏膜下剥离术 

分 类 号：R656.6[医药卫生—外科学]