橡皮圈牵引辅助技术在食管早癌内镜黏膜下剥离术中的应用研究  

Application of rubber band traction assisted technique in endoscopic submucosal dissection of early esophageal cancer

作　　者：谢汶甫 韦明勇[1] 石小琼[1] 彭薛 何美林 舒巧 XIE Wenfu;WEI Mingyong;SHI Xiaoqiong;PENG Xue;HE Meilin;SHU Qiao(Department of Gastroenterology,Sichuan Science City Hospital,Sichuan Mianyang 621900,China)

机构地区：[1]四川省科学城医院消化内科,四川绵阳621900

出　　处：《现代肿瘤医学》2023年第13期2463-2466,共4页Journal of Modern Oncology

基　　金：中国消化道早癌医生共同成长计划科研项目(编号:GTCZ-2020-SC-51-0017)。

摘　　要：目的:观察食管早癌内镜黏膜下剥离术中应用橡皮圈牵引辅助技术的临床价值。方法:选取2020年01月至2022年05月本院收治的食管早癌患者86例,均行内镜黏膜下剥离术(ESD),以随机数字表法分为牙线组(43例,牙线牵引辅助技术)、橡皮圈组(43例,橡皮圈牵引辅助技术)。比较两组围术期相关指标;比较术前、术后1 d、术后3 d两组应激指标变化;比较两组手术结果,术中、术后并发症,随访结果。结果:与牙线组比较,橡皮圈组手术时间缩短,进镜及退镜次数、补充注射次数减少,止血夹脱离率降低(P<0.05)。术后1、3 d,与牙线组比较,橡皮圈组血清皮质醇(Cor)、前列腺素E2(PEG2)、P物质(SP)水平均降低(P<0.05)。所有患者均成功行ESD手术,牙线组病变整块切除率、完全切除率、一次性根治性切除率分别为100%、100%、97.67%,1例因黏膜下深浸润癌,未达到一次性根治性切除;橡皮圈组病变整块切除率、完全切除率、一次性根治性切除率均为100%。所有患者术中均无大量出血、穿孔,术后无狭窄发生。随访至2022年11月,随访时间6~34个月,中位随访时间16个月。牙线组有1例在14个月时追加外科手术及放疗,后续随访未复发,其余患者均未发生淋巴结转移或复发。结论:食管早癌ESD中应用橡皮圈牵引辅助技术可缩短手术时间、减轻术后应激,减少进镜及退镜次数、补充注射次数,装置不易脱离,且可完整根治病变,安全有效。Objective:To observe the clinical value of rubber band traction assisted technique in endoscopic submucosal dissection of early esophageal cancer.Methods:A total of 86 patients with early esophageal cancer admitted to our hospital from January 2020 to May 2022 were selected,all of whom underwent endoscopic submucosal dissection(ESD).They were divided into dental floss group(43 cases,floss traction aid)and rubber band group(43 cases,rubber band traction aid)by random number table method.The perioperative indexes and stress indexes of preoperative,postoperative 1,3 d between the two groups were compared.The surgical results,intraoperative and postoperative complications and follow-up results between the two groups were compared.Results:Compared with the dental floss group,the operation time was shorter,the times of injection and withdrawal,supplementary injection were less,and the rate of tourniquet disengagement was lower in rubber band group(P<0.05).On day 1 and 3 after surgery,compared with the dental floss group,the levels of serum cortisol(Cor),prostaglandin E2(PEG2)and substance P(SP)in rubber band group were lower(P<0.05).All patients underwent ESD surgery,and the lump resection rate of whole block,complete resection rate and one-time radical resection rate of dental floss group lesions were 100%,100%and 97.67%,respectively,and one case did not achieve one-time radical resection due to deep submucosal invasive carcinoma.The resection rate of whole block,complete resection rate and one-time radical resection rate in rubber band group were all 100%.All patients did not have heavy bleeding or perforation during surgery,and no stenosis occurred after surgery.All patients were followed up until November 2022,with a follow-up period of 6~34 months and a median follow-up of 16 months.In the dental floss group,one patient had surgery and radiotherapy at 14 months and there was no recurrence during follow-up.The rest of the patients did not develop lymph node metastasis or recurrence.Conclusion:The application of rub

关 键 词：食管早癌 内镜黏膜下剥离术 橡皮圈 牙线 牵引辅助 

分 类 号：R735.1[医药卫生—肿瘤]