橡皮圈腔内牵引辅助内镜黏膜下剥离术在右半结肠侧向发育型肿瘤治疗中的应用  

APPLICATION OF ENDOSCOPIC SUBMUCOSAL DISSECTION WITH RUBBER BAND TRACTION IN TREATMENT OF LATE-RALLY SPREADING TUMOR IN THE RIGHT HEMICOLON

作　　者：陈相波[1] 宋玉琼[2] 许婷婷[1] 何壬松 王育斌[3] CHEN Xiangbo;SONG Yuqiong;XU Tingting;HE Rensong;WANG Yubin(Endoscopy Room,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院内窥镜室,福建泉州362000 [2]福建医科大学附属泉州第一医院神经内科,福建泉州362000 [3]福建医科大学附属泉州第一医院消化内科,福建泉州362000

出　　处：《精准医学杂志》2022年第3期204-207,212,共5页Journal of Precision Medicine

基　　金：泉州市科技计划项目(2018Z067)。

摘　　要：目的探讨橡皮圈腔内牵引辅助内镜黏膜下剥离术(ESD)在右半结肠侧向发育型肿瘤(laterally spreading tumor,LST)中的疗效和安全性。方法选择2019年1月—2020年6月在我院行ESD治疗的右半结肠LST患者42例,随机分为两组,其中22例行橡皮圈腔内牵引辅助ESD(试验组),20例行传统ESD(对照组),比较两组患者术中黏膜下注射液体量、肿瘤剥离时间、手术时间、术中改变体位次数、术中出血量,同时比较两组患者病灶一次性完整切除情况、术后肌层损伤情况、穿孔发生情况、住院时间,并对患者术后随访2~30个月。结果两组患者的肿瘤大小、肿瘤类型、肿瘤部位、病理类型、肿瘤浸润深度、一次性完整切除情况比较差异无显著性(P>0.05),而两组患者的治愈性切除情况、手术时间、肿瘤剥离时间、黏膜下注射液体量、术中改变体位次数、术中出血量、住院时间比较差异均有显著性(t=3.719~15.937,χ^(2)=4.887,P<0.05)。试验组术中未发生穿孔及不可控制的出血,2例出现固有肌层损伤,对照组术中4例出现固有肌层损伤,3例出现小穿孔,试验组固有肌层损伤及穿孔发生情况明显低于对照组(χ^(2)=4.177,P<0.05)。随访期间两组患者未发生迟发性出血及穿孔等情况,创面均愈合良好,无肿瘤局部复发情况。结论橡皮圈腔内牵引辅助ESD治疗右半结肠LST可显著提高临床疗效,安全性高,且术中操作简单,取材方便,价格便宜,值得在临床应用推广。Objective To investigate the efficacy and safety of endoscopic submucosal dissection(ESD)with rubber band traction in the treatment of laterally spreading tumor(LST)in the right hemicolon.Methods A total of 42 patients with LST in the right hemicolon who underwent ESD in our hospital from January 2019 to June 2020 were enrolled and randomly divided into experimental group(22 patients undergoing ESD with rubber band traction)and control group(20 patients undergoing traditional ESD).The two groups were compared in terms of intraoperative submucosal injection volume,tumor stripping time,time of ope-ration,number of body position changes during surgery,and intraoperative blood loss,as well as complete single resection of lesion,postoperative muscular injury,perforation,and length of hospital stay,and the patients were followed up for 2—30 months to observe prognosis.Results There were no significant differences between the two groups in tumor size,tumor type,tumor location,pathological type,depth of tumor invasion,and complete single resection of lesion(P>0.05),and there were significant differences between the two groups in curative resection,time of operation,tumor stripping time,submucosal injection volume,number of body position changes during surgery,intraoperative blood loss,and length of hospital stay(t=3.719-15.937,χ^(2)=4.887,P<0.05).No intraoperative perforation and uncontrollable bleeding occurred in the experimental group,and 2 patients experienced muscularis propria injury;in the control group,4 patients experienced muscularis propria injury and 3 experienced small perforation;the experimental group had significantly lower incidence rates of muscularis propria injury and perforation than the control group(χ^(2)=4.177,P<0.05).No delayed bleeding or perforation was observed during follow-up,and all wounds healed well without local tumor recurrence.Conclusion ESD with rubber band traction can significantly and safely improve clinical outcome in the treatment of LST in the right hemicolon,with the advant

关 键 词：内窥镜黏膜切除术 结直肠肿瘤 右半结肠 牵引术 橡皮圈 钛夹 治疗结果 

分 类 号：R656.6[医药卫生—外科学] R735.34[医药卫生—临床医学]