注水黏膜切开刀推进式内镜黏膜下剥离术快速切除贲门大面积早期癌及其癌前病变的应用初探  

Application of pushing endoscopic submucosal dissection in large area of early cancer and precancerous lesions of cardia

作　　者：熊英 韩静[1] 朱亚男 陈玉杰[2] 侯丛然 于占江[2] 高雪梅 张金卓[1] Xiong Ying;Han Jing;Zhu Yanan;Chen Yujie;Hou Congran;Yu Zhanjiang;Gao Xuemei;Zhang Jinzhuo(Third Department of Gastroenterology,Baoding NO.1 Central Hospital,Baoding 071000,China;Endoscopy Center,Baoding NO.1 Central Hospital,Baoding 071000,China;Key Laboratory of Molecular Pathology and Early Diagnosis of Tumor in Hebei Province,Baoding 071000,China)

机构地区：[1]保定市第一中心医院消化三科,071000 [2]保定市第一中心医院内镜诊疗中心,071000 [3]河北省分子病理与肿瘤早期诊断重点实验室,保定071000

出　　处：《中华消化内镜杂志》2021年第6期479-483,共5页Chinese Journal of Digestive Endoscopy

摘　　要：探讨推进式内镜黏膜下剥离术(pushing endoscopic submucosal dissection,PESD)在大面积早期贲门癌及其癌前病变中的应用价值。2017年1月—2020年1月在保定市第一中心医院内镜诊疗中心确诊早期贲门癌或高级别上皮内瘤变,且病变最大径>2.0 cm的患者纳入研究。术中应用注水黏膜切开刀(黄金刀)行PESD的患者纳入PESD组(26例),与同期该医师以普通黏膜切开刀行常规ESD治疗的患者(常规ESD组,17例)进行对比,分析2组剥离时间、病变完整切除率、出血及穿孔等并发症发生率。2组病变大小比较差异无统计学意义(P>0.05),PESD组剥离时间为(53.7±18.2)min,常规ESD组为(91.5±26.5)min,差异有统计学意义(P<0.001)。PESD组7例(26.9%)术中出血,常规ESD组8例(47.1%)术中出血,2例(11.8%)术中穿孔,无迟发性出血及迟发性穿孔。2组出血及穿孔发生率比较差异均有统计学意义(P<0.001)。可见,大面积贲门病变应用注水黏膜切开刀行PESD与常规ESD相比可有效提高剥离速度,降低并发症发生率,使内镜手术更安全、更快捷。To explore the application value of pushing endoscopic submucosal dissection(PESD)in treatment of large area of early cardiac cancer or precancerous lesions.Form January 2017 to January 2020,patients diagnosed as having early cardiac cancer or high-grade intraepithelial neoplasia with largest lesion diameter greater than 2.0 cm at the Baoding NO.1 Central Hospital were enrolled in the study.Patients who received PESD with water-injected knife were included in the PESD group(26 cases),and compared with those who received conventional ESD with common mucosal incision(the conventional ESD group,17 cases)at the same period.The procedure time,the complete resection rate of lesions and the incidence of complications were analyzed.There were no difference in lesion size between the two groups(P>0.05).The procedure time of PESD group was 53.7±18.2 min,which was 91.5±26.5 min in the conventional ESD group,and the difference was statistically significant(P<0.001).In the PESD group,7 cases(26.9%)had intraoperative hemorrhage.In the conventional ESD group,8 cases(47.1%)had intraoperative bleeding,and 2(11.8%)had intraoperative perforation.There were significant differences in the incidence of hemorrhage and perforation between the two groups(all P<0.001).Compared with conventional ESD,PESD can effectively improve the dissection speed,reduce the incidence of complications,and make endoscopic surgery safer and faster.

关 键 词：贲门 内镜黏膜下剥离术 注水黏膜切开刀 早期癌 癌前病变 

分 类 号：R735.2[医药卫生—肿瘤]