体外牵引辅助在基层医院困难ESD中的应用价值  

Application of traction In vitro assisted technique in difficult endoscopic submucosal dissection for early gastrointestinal tumors

作　　者：曹友红 凌亭生[2] 张志刚 庄端明 邢一鸣 傅启英 赵静[1] 王小平 CAO You-hong;LING Ting-sheng;ZHANG Zhi-gang;ZHUANG Duan-ming;XING Yi ming;FU Qi-ying;ZHAO Jing;WANG Xiao-ping(Department of Gastroenterology,Gaogu Branch,Affiliated Drum Tower Hospital,School of Medicine,Nanjing University;Department of Gastroenterology,Affiliated Drum Tower Hospital,School of Medicine,Nanjing University;Gucheng Center Hospital,Nanjing 211300,Jiangsu Province,China)

机构地区：[1]南京大学附属鼓楼医院高淳分院消化科,211300 [2]南京大学附属鼓楼医院消化科,2210008 [3]南京市固城中心医院,211300

出　　处：《现代消化及介入诊疗》2020年第7期865-870,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：南京市科技发展计划项目(201715079)。

摘　　要：目的研究基层医院体外牵引辅助内镜黏膜下剥离术(ESD)在消化道管腔困难部位的应用效果及价值。方法收集南京大学附属鼓楼医院高淳分院2017年10月至2019年12月经胃镜(放大+NBI)及活检病理检查判断仅局限于黏膜层、未侵及管壁固有肌层的早期消化道肿瘤及部分浅表黏膜下瘤体、类癌等患者81例,其中30例采用常规ESD治疗不辅助牵引(不牵引组),51例采取牵引技术辅助ESD术:牵引技术中12例采取牙线辅助牵引(牙线牵引组),39例采取圈套器辅助牵引(圈套器牵引组);记录和评估3组患者手术部位、病灶有无溃疡、手术持续时间、病灶切除大小、住院天数、手术者感觉舒适程度、单位时间内切割面积、一次性整块切除率、一次性R0完全切除率、并发出血、穿孔发生率,肿瘤分化程度等情况。结果牙线牵引组、圈套器牵引组较不牵引组,病灶完整剥离时间[(53.27±17.16)min、(67.95±19.36)min]比(85.77±24.59)min,P<0.05]明显缩短,单位时间内切除面积[(27.44(15.00,28.36)mm^2/min、16.78(12.32,30.97)mm^2/min]比10.27(8.55,14.49)mm^2/min,P<0.05]明显提高;住院天数[(6.05±0.47)天、(6.64±0.95)天]比(6.95±0.99)天明显下降。牙线牵引法、圈套器牵引法辅助下的ESD手术者舒适度明显高于不牵引组,3组比较分析一次性整块切除率、ESD术后并发症(出血或穿孔)及ESD术后大病理分化类型、患者病变黏膜病变表面有无溃疡均无明显差异(P>0.05)。结论体外牵引辅助ESD(牙线牵引和圈套器牵引),可明显提高黏膜切除的效率,对基层医院开展ESD具有较好的推广应用价值。Objective To study the value of traction In vitro assisted technique in difficult endoscopic submucosal dissection for early gastrointestinal tumors in the grass-roots hospitals.Methods 81 patients recived ESD for early gastrointestinal tumors and SMT or carcinoid from October 2017 to December 2019 were randomly divided into snare traction group(n=38),dental floss traction group(n=12)and not pulling group(n=30).To compare operating position,the duration of the operation time,lesions with or without ulcers,lesion resection of size,hospital stay,comfortable degree of surgery,cutting area per unit time,complete resection rate,R0 resection rate,complications and the tumor differentiation degree results of the three groups.Results Dental floss traction,snare traction group than the not pulling group,the duration of the operation time[(53.27±17.16)min and(67.95±19.36)min]than(85.77±24.59)min,P<0.05)significantly shortened,cutting area per unit time[(27.44(15.00,28.36)mm^2/min,16.78(12.32,30.97)mm^2/min]than 10.27(8.55,14.49)mm^2/min,P<0.05)increased significantly;Hospitalization days[(6.05±0.47),(6.64±0.95)days]significantly lower than(6.95±0.99)day.Dental floss traction method,snare traction method aided by ESD operation comfort is significantly higher than those not pulling group,3 group of comparative analysis of one-time whole block resection,ESD postoperative complications(bleeding or perforation)and ESD in patients with postoperative pathological differentiation type,lesion mucosa lesion surface had ulcer were no obvious difference(P>0.05).Conclusion External traction auxiliary ESD(dental floss and snare traction),can obviously improve the efficiency of the mucous membrane excision,the primary hospitals in ESD technique has good application value.

关 键 词：体外牵引辅助 内镜黏膜下剥离术 早期消化道肿瘤 癌前病变 

分 类 号：R571[医药卫生—消化系统] R573[医药卫生—内科学]