人源性纤维蛋白胶对食管病变内镜黏膜剥离术后并发症的防治效果分析  

Effects of human-derived fibrin glue for preventing postoperative complications of endoscopic submucosal dissection for esophageal lesions

作　　者：刘洋[1] 雷思雨 魏宁 仲之恒 施瑞华[1,2] Liu Yang;Lei Siyu;Wei Ning;Zhong Zhiheng;Shi Ruihua(Deparment of Gastroenterology,Zhongda Hospital Afiliated to Southeast University,Nanjing 210009,China;School of Medicine,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院消化内科,南京210009 [2]东南大学医学院,南京210009

出　　处：《中华消化内镜杂志》2021年第11期882-887,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价人源性纤维蛋白胶对食管早期鳞癌及癌前病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后并发症的防治效果。方法将2017年4月-2020年4月因食管早期鳞癌或癌前病变在东南大学附属中大医院消化内科行ESD治疗的210例病例纳入回顾性分析,其中退镜前创面使用人源性纤维蛋白胶预防术后并发症的73例(79处病变)纳入观察组,剩余137例未使用者(156处病变)纳入对照组,对比分析2组ESD术后并发症及术后疼痛发生情况。结果2组在患者一般资料及病变位置、纵径大小、巴黎分型、病理类型、浸润深度、病变环周范围、剥离面积、手术时长和局部使用激素方面,差异均无统计学意义(P>0.05)。穿孔、迟发性出血和食管狭窄发生率观察组分别为2.7%(2/73)、1.4%(1/73)和16.4%(12/73),对照组分别为2.9%(4/137)、1.5%(2/137)、13.1%(18/137),2组间差异均无统计学意义(P>0.05)。术后疼痛总体发生率观察组为53.4%(39/73),对照组为70.8%(97/137),2组间差异有统计学意义(χ^(2)=6.302,P=0.012)。其中,轻度疼痛、中度疼痛和重度疼痛发生率手术当天观察组分别为9.6%(7/73)、6.8%(5/73)和5.5%(4/73),对照组分别为27.0%(37/137,χ^(2)=8.724,P=0.003)、17.5%(24/137,χ^(2)=4.554,P=0.033)和0.7%(1/137,χ^(2)=2.805,P=0.094);术后第1天观察组分别为26.0%(19/73)、5.5%(4/73)和6.8%(5/73),对照组分别为29.2%(40/137,χ^(2)=0.237,P=0.626)、14.6%(20/137,χ^(2)=3.912,P=0.048)和4.4%(6/137,χ^(2)=0.193,P=0.660);术后第2天观察组分别为5.5%(4/73)、0和1.4%(1/73),对照组分别为19.0%(26/137,χ^(2)=7.087,P=0.008)、2.9%(4/137)和0。结论人源性纤维蛋白胶对食管早期鳞癌及癌前病变ESD术后出血、穿孔、狭窄无明显预防作用,但可显著降低ESD术后疼痛的发生率,尤其是术后轻-中度疼痛的发生率。Objective To explore the ffects of human-derived fibrin glue on prevention of postoperative complications of endoscopie submucosal disction(ESD)in early esophageal squamous cancer and preeancerous lesions.Methods A total of 210 patients with early esophageal squamous cancer or precancerous lesions who underwent ESD at Department of Gastroenterology,Zhongda Hospital Afiliated to Southeast University from April 2017 to April 2020 were ineluded in this retrospective study.Seventy-three cases(79 esophageal lesions)where human-derived fibrin glue was used before retrieving endoscope were included in the observation group,while 137 cases(156 esophageal lesions)where fibrin glue was not used were included in the control group.The postoperative complications and pain were compared between the two groups.Results Clinical datia ineluding general information,longitudinal length,Paris type,pathological type,invasion depth,circumferential range,area of resecion,duration of operation and local steroid used were similar between the two groups(P>0.05).The incidences of perforation,delayed bleeding and esophageal stenosis in the observation group were 2.7%6(2/73).1.4%(1/73),and 16.4%(12/73).respectively,and were 2.9%(4/137),1.5%(2/137),and 13.1%(18/137),respetively in the control group.There were no signifcant differences between the two groups(P>0.05).The incidence of postoperative pain in the observation group was 53.4%(39/73),which was significantly lower than that in the control group of 70.8%(97/137)(χ^(2)=6.302,P=0.012).The incidences of mild,moderate and severe pain in observation group on the day of ESD were9.6%(7/73).6.8%(5/73)and5.5%(4/73).respectively,and 27.0%(37/137,χ^(2)=8.724,P=0.003),17.5%(24/137.χ^(2)=4.554,P=0.033)and 0.7%(1/137.χ^(2)=2.805,P=0.094),respectively in the control group.The incidences of mild,moderate and severe pain in the observation group on the first day after the operation were 26.0%(19/73).5.5%(4/73)and 6.8%(5/73),respectively,and 29.2%(40/137,χ^(2)=0.237,P=0.626),14.6%(20/137,χ^(2)=3.91

关 键 词：食管肿瘤 食管早期鳞癌 内镜黏膜下剥离术 纤维蛋白胶 术后并发症 术后疼痛 

分 类 号：R735.1[医药卫生—肿瘤]