透明帽辅助的内镜下全层切除术与黏膜剥离术治疗胃黏膜下小肿瘤的临床效果比较  

Comparison of the clinical effect of cap-assistted endoscopic full thickness resection and endoscopic submuscosal dissection for gastric small submucosal tumors

作　　者：陆翠钦 郭少山 李达周 郑仁斌 LU Cuiqin;GUO Shaoshan;LI Dazhou;ZHENG Renbin(Department of Gastroenterology,Mindong Hospital of Ningde City,Fujian Province,Ningde355000,China;Department of Gastroenterology,the 900th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army,Fujian Province,Fuzhou350000,China)

机构地区：[1]福建省宁德市闽东医院消化内科,福建宁德355000 [2]中国人民解放军联勤保障部队第九〇〇医院消化内科,福建福州350000

出　　处：《中国当代医药》2023年第13期62-66,共5页China Modern Medicine

基　　金：福建省宁德市医技提升科研项目(2020005)。

摘　　要：目的探讨透明帽辅助的内镜下全层切除术(Cap-EFTR)与内镜下黏膜剥离术(ESD)治疗胃黏膜下小肿瘤疗效及安全性。方法回顾性选取2018年1月至2022年7月宁德市闽东医院消化内科诊治的72例胃黏膜下小肿瘤患者作为研究对象,根据手术方式不同分为研究组(n=38)和对照组(n=34),其中研究组采用Cap-EFTR治疗,对照组使用ESD治疗,比较两组患者手术情况[手术时间、肿物切除时间、术中钛夹适应量、整块切除率、R0切除率],术后情况(发热、腹膜炎、气腹、恢复进食时间、术后住院时间、抗生素使用情况);同时比较两组患者术前及术后白细胞总数、中性粒细胞比例、超敏C反应蛋白(hs-CRP)水平变化。结果研究组术中整块切除率为97.36%(37/38),R0切除率为97.36(37/38),对照组术中整块切除率为97.06%(32/34),R0切除率为94.1%(32/34),两组患者术中整块切除率和R0切除率比较,差异无统计学意义(P>0.05)。研究组总手术时间、肿物切除时间、术后恢复饮食时间、术后住院时间短于对照组,术中钛夹使用数量少于对照组,抗生素使用率低于对照组,差异均有统计学意义(P<0.05)。术后,两组患者的白细胞总数、中性粒细胞比例、hs-CRP水平高于本组术前,研究组的白细胞总数、中性粒细胞比例、hs-CRP水平低于对照组,差异有统计学意义(P<0.05)。结论ESD和Cap-EFTR均能有效切除胃黏膜下小肿瘤,但Cap-EFTR更加快捷、耗材更少、费用更低,且能缩短胃黏膜下小肿瘤患者术后恢复时间,对炎症反应的控制效果好,且并发症少,是一种安全有效的手术方式。Objective To investigate the efficacy and safety of cap-assisted endoscopic full thickness resection(Cap-EFTR)and endoscopic submuscosal dissection(ESD)in the treatment of small gastric submucosal tumors.Methods A retrospective study was conducted on 72 patients with small gastric submucosal tumors diagnosed and treated in the Department of Gastroenterology,Mindong Hospital of Ningde City from January 2018 to July 2022.They were divided into a study group(n=38)and a control group(n=34)based on different surgical methods,the study group received Cap-EFTR treatment and the control group received ESD treatment.Compare the surgical conditions of the two groups of patients(surgical time,tumor removal time,intraoperative titanium clip adaptation,overall resection rate,R0 resection rate)and postoperative conditions(fever,peritonitis,pneumoperitoneum,time to resume eating,postoperative hospital stay and antibiotic use).At the same time,the changes in the total number of white blood cells,the proportion of neutrophils,and the level of hypersensitive C-reactive protein(hs-CRP)were compared between the two groups before and after surgery.Results The intraoperative total resection rate was 97.36%(37/38)in the study group,and the R0 resection rate was 97.36%(37/38)in the control group.The intraoperative total resection rate was 97.06%(32/34)and the R0 resection rate was 94.1%(32/34)in the control group,there were no statistically significant differences between the intraoperative total resection rate and the R0 resection rate in the two groups(P>0.05).The total surgical time,tumor removal time,postoperative dietary recovery time and postoperative hospitalization time in the study group were shorter than those in the control group,the number of titanium clips used during surgery was less than that in the control group,and the antibiotic use rate was lower than that in the control group,with significant differences(P<0.05).After surgery,the total number of white blood cells,the proportion of neutrophils and the level of hs-CRP

关 键 词：超声内镜 胃黏膜下肿瘤 透明帽辅助的内镜下全层切除术 内镜下黏膜剥离术 

分 类 号：R735.2[医药卫生—肿瘤]