牙线牵引辅助改良圈套器行内镜粘膜下剥离术切除消化道早期病变的临床应用研究  

Clinical Application Of Endoscopic Submucosal Dissection With Floss Traction Assisted By Modified Snare In The Resection Of Early Gastrointestinal Lesions

作　　者：易世勇 陈文峰 吴文华 范文伟 YI Shi-yong;CHEN Wen-feng;WU Wen-hua;FAN Wen-wei(Dongguan Eighth People's hospital,DongGuan 523000)

机构地区：[1]东莞市第八人民医院,广东省523000

出　　处：《岭南急诊医学杂志》2023年第6期561-563,567,共4页Lingnan Journal of Emergency Medicine

基　　金：广东省医学科学技术研究基金项目(B2022319)。

摘　　要：目的:研究牙线牵引辅助改良圈套器行内镜粘膜下剥离术切除消化道早期病变的临床应用。方法:回顾性分析我院近年来收治的消化道早期病变的病人94例,采用随机对照实验方法,根据治疗方法不同分为2组:A组:传统手术组,使用啄木鸟切开刀进行ESD术;B组:改良手术组,使用牙线牵引辅助改良圈套器进行ESD术,改良圈套器即将普通圈套器尖端突出2 mm左右,代替常规电切刀,同时加用牙线牵引辅助下用改良圈套器进行粘膜下剥离,然后分别从手术完整切除率、手术时间、手术费用、术后并发症、术后平均住院天数等方面进行对比。结果:两组手术完成率均为100%,两组完整切除率、术后住院天数、术后并发症发生率均无统计学意义(P>0.05)。但改良手术组手术时间明显少于传统手术组[(62.52±8.20)minvs(75.70±12.03)min,P<0.05]。改良手术组产生费用明显少于传统手术组[(4737.94±330.14)元vs(7571.76±875.51)元,P<0.05]。结论:使用牙线牵引辅助改良圈套器行ESD术安全、有效,在缩短手术时间、降低手术费用具有很大的优势,同时并无增加住院时间及增加并发症的发生,不单提高了手术效率,同时明显减轻了患者的负担,可以造福广大患者。Objective:To investigate the clinical application of endoscopic submucosal dissection with floss traction assisted by modified snare in the resection of early gastrointestinal lesions.Methods:94 patients with early digestive tract lesions admitted to our hospital in recent years were retrospectively analyzed and divided into 2 groups according to different treatment methods by randomized controlled experiment:Group A:traditional operation group,ESD operation was performed with woodpecker cutter;Group B:In the improved surgery group,ESD operation was performed using a modified snare assisted by floss traction.The modified snare was about 2mm protruding from the tip of the ordinary snare instead of conventional electric cutting knife.At the same time,submucosal dissection was performed with the modified snare assisted by floss traction.Then,the complete resection rate,operation time,operation cost,postoperative compli-cations,and average postoperative hospitalization days were compared.Results:The surgical completion rate was 100%in both groups,and there was no statistical significance in the complete resection rate,postoperative hospitalization days and postoperative complications in both groups(P>0.05).However,the operation time of the modified operation group was significantly less than that of the traditional operation group[(62.52±8.20)min vs(75.70±12.03)min,P<0.05].The cost of the modified operation group was significantly lower than that of the traditional operation group[(4737.94±330.14)yuan vs(7571.76±875.51)yuan,P<0.05].Conclusion:Using floss traction assisted modified snare to per-form ESD surgery is safe and effective,and has great advantages in shortening operation time and reducing operation cost,without increasing hospital stay and complications.It not only improves operation efficiency,but also significantly reduces the burden of patients,which can benefit the majority of patients.

关 键 词：内镜粘膜下剥离术(ESD术) 改良圈套器(圈套器尖端) 牙线牵引 

分 类 号：R57[医药卫生—消化系统]