牙线牵引辅助内镜黏膜下剥离术治疗胃角黏膜病变的疗效(含视频)  

Efficacy of dental floss traction-assisted endoscopic submucosal dissection for gastric angle mucosal lesions(with video)

作　　者：庄惠军[1] 沈许德 陈进忠[1] 姚礼庆[1] 苏红 郑永胜[1] 雷天霞[1] 杨炜琳[1] 吴建海[1] 陈金海 王海星 谢逸林 Zhuang Huijun;Shen Xude;Chen Jinzhong;Yao Liqing;Su Hong;Zheng Yongsheng;Lei Tianxia;Yang Weilin;Wu Jianhai;Chen Jinhai;Wang Haixing;Xie Yilin(Department of Endoscopy Center,The First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Gastroenterology,The Affiliated Success Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]厦门大学附属第一医院内镜中心,361003 [2]厦门大学附属成功医院消化内科,361003

出　　处：《中华消化内镜杂志》2020年第9期642-646,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨牙线牵引辅助内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃角黏膜病变的疗效。方法回顾性分析2015年1月—2018年12月厦门大学附属第一医院内镜中心收治的127例胃角黏膜病变患者病例资料。根据术中手术方法,将患者分为牙线牵引辅助ESD组(牵引组,n=51)和传统ESD组(传统组,n=76),同时把41例胃角纤维化病例也分为牵引组(n=23)和传统组(n=18)。对比分析手术时间、整块切除率、治愈性切除率及出血、肌层损伤、穿孔等不良事件发生率等指标。结果牵引组与传统组病例年龄、性别、病变大小及病变形态差异无统计学意义(P>0.05)。牵引组手术时间较传统组明显缩短[(65.4±36.5)min比(103.5±43.2)min,P=0.012],病变整块切除率[100.00%(51/51)比90.79%(69/76),P=0.026]及治愈性切除率均更高[94.12%(48/51)比81.58%(62/76),P=0.042],且剥离过程中肌层损伤[5.88%(3/51)比25.00%(19/76),P=0.010]及术中出血更少[47.06%(24/51)比82.89%(63/76),P=0.010]。传统组2例(2.63%)纤维化病例穿孔,牵引组无穿孔病例,穿孔发生率差异无统计学意义(P=0.243)。在胃角纤维化病例中,牵引组手术时间较传统组明显缩短[(81.4±29.3)min比(119.3±37.6)min,P=0.010],病变整块切除率[100.00%(23/23)比72.22%(13/18),P=0.007]及治愈性切除率均更高[95.65%(22/23)比72.22%(13/18),P=0.035],且剥离过程中肌层损伤[8.70%(2/23)比72.22%(13/18),P=0.001]及术中出血更少[78.26%(18/23)比100.00%(18/18),P=0.035]。结论牙线牵引辅助ESD治疗胃角黏膜病变及有纤维化的胃角病变安全有效,与传统ESD相比,手术时间更短,治愈率更高,不良事件发生率更低。Objective To study the efficacy of dental floss traction-assisted endoscopic submucosal dissection(ESD)for gastric angle mucosal lesions.Methods Data of 127 patients with gastric angle mucosal lesions admitted to the endoscopic center of the First Affiliated Hospital of Xiamen University from January 2015 to December 2018 were retrospectively analyzed.According to the surgical methods,patients were divided into the dental floss traction-assisted ESD group(the traction group,n=51)and the traditional ESD group(the traditional group,n=76).The 41 fibrosis cases were further divided into the traction group(n=23)and the traditional group(n=18).The operation time,en block resection rate,curative resection rate and the incidence of adverse events such as bleeding,muscle layer injury and perforation were compared between the two groups.Results There was no significant difference in age,sex,lesion size or morphology between the traction group and the traditional group(P>0.05).The operation time of the traction group was significantly shorter than that of the traditional group(65.4±36.5 min VS 103.5±43.2 min,P=0.012).The en block resection rate was higher in the traction group[100.00%(51/51)VS 90.79%(69/76),P=0.026],and the curative resection rate was higher too[94.12%(48/51)VS 81.58%(62/76),P=0.042].The incidences of muscular layer damage[5.88%(3/51)VS 25.00%(19/76),P=0.010]and intraoperative bleeding[47.06%(24/51)VS 82.89%(63/76),P=0.010]were lower in the traction group.Perforation occurred in two patients(2.63%)of fibrosis in the traditional group;no perforation occurred in the traction group.There was no significant difference in the perforation incidence(P=0.243).In the cases of fibrosis,the operation time of the traction group was significantly shorter compared with that of the traditional group(81.4±29.3 min VS 119.3±37.6 min,P=0.010).The en block resection rate and curative resection rate were also higher in the traction group[100.00%(23/23)VS 72.22%(13/18),P=0.007;95.65%(22/23)VS 72.22%(13/18),P=0.035].The inci

关 键 词：纤维化 牵引力 牙线 胃角 黏膜病变 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]