单钛夹辅助牵引在十二指肠内镜黏膜下剥离术中的应用价值  

Application of single metal clip traction to endoscopic submucosal dissection for duodenal lesions

作　　者：朱丹丹[1] 窦晓坛 郭慧敏[1] 陈敏[1] 王雷[1] 于成功[1] Zhu Dandan;Dou Xiaotan;Guo Huimin;Chen Min;Wang Lei;Yu Chenggong(Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化科,南京210008

出　　处：《中华消化内镜杂志》2024年第9期707-711,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价单钛夹辅助牵引用于十二指肠内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)的安全性及有效性。方法2021年4月至2022年10月,因十二指肠病变在南京大学医学院附属鼓楼医院行ESD治疗,采用单钛夹辅助牵引(单钛夹辅助牵引ESD组,n=19)或未采用任何牵引方法(传统ESD组,n=26)的病例纳入回顾性队列研究,主要观察2组的并发症发生情况、单位时间切除面积、整块切除率和R0切除率,次要观察指标包括标本长径、横径、面积等。结果45例均成功完成ESD治疗,单钛夹辅助牵引ESD组手术用时44.0(27.0,67.0)min,传统ESD组手术用时34.0(24.0,43.5)min(Z=-1.678,P=0.093)。单钛夹辅助牵引ESD组共有2例(10.5%)发生并发症,包括1例术中穿孔和1例术后呕血(量约20 mL);传统ESD组共有3例(11.5%)发生并发症,包括1例术后呕血(量约50 mL)和2例术后穿孔。2组并发症总体发生率比较,差异无统计学意义(P=1.000)。单钛夹辅助牵引ESD组单位时间切除面积为16.0(11.0,25.8)mm^(2)/min,明显大于传统ESD组的5.3(2.2,21.1)mm^(2)/min(Z=-2.287,P=0.022)。单钛夹辅助牵引ESD组整块切除率和R0切除率均达100.0%(19/19),其标本长径、横径、面积分别为34.0(22.0,45.0)mm、25.0(20.0,34.0)mm、745.8(380.0,1342.4)mm^(2),均明显大于传统ESD组的20.0(12.8,30.3)mm(Z=-3.119,P=0.002)、14.0(8.8,21.3)mm(Z=-3.417,P=0.001)、190.4(84.0,498.7)mm^(2)(Z=-3.275,P=0.001)。结论单钛夹辅助牵引用于十二指肠ESD安全、有效,可以明显提高剥离效率,尤其适用于病变面积大的十二指肠ESD。Objective To assess the safety and efficacy of single metal clip traction-assisted endoscopic submucosal dissection(ESD)for the treatment of duodenal lesions.Methods Data of 45 patients with duodenal lesions who underwent ESD in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between April 2021 and October 2022 were retrospectively recruited.Among them,19 patients received single metal clip traction-assisted ESD while 26 patients received traditional ESD.The incidence of complications,dissection speed,en bloc resection rate and R0 resection rate of the two groups were mainly observed.Secondary observation indexes included specimen longer diameter,shorter diameter and area.Results All 45 procedures were successfully completed,with the procedure time of 44.0(27.0,67.0)min for the single metal clip traction-assisted ESD group and 34.0(24.0,43.5)min for the traditional ESD group(Z=-1.678,P=0.093).In the single metal clip traction-assisted ESD group,2 cases(10.5%)had complications,including 1 intraoperative perforation and 1 postoperative bleeding(approximately 20 mL).There were three cases(11.5%)of complications in the traditional ESD group,including 1 case of postoperative bleeding(approximately 50 mL)and 2 cases of postoperative perforation,with no significant intergroup variation(P=1.000).The dissection speed of the single metal clip traction-assisted ESD group was 16.0(11.0,25.8)mm^(2)/min,significantly larger than that of the traditional ESD group[5.3(2.2,21.1)mm^(2)/min,Z=-2.287,P=0.022].The en block resection rate and R0 resection rate of the single metal clip traction-assisted ESD group were both 100.0%(19/19).Additionally,the specimen longer diameter,shorter diameter and area of the single metal clip traction-assisted ESD group were 34.0(22.0,45.0)mm,25.0(20.0,34.0)mm,and 745.8(380.0,1342.4)mm^(2),respectively,significantly larger than those of the traditional ESD group of 20.0(12.8,30.3)mm(Z=-3.119,P=0.002),14.0(8.8,21.3)mm(Z=-3.417,P=0.001),190.4(84.0,498.7)mm^(2)(Z

关 键 词：十二指肠 内镜黏膜下剥离术 内牵引 单钛夹 

分 类 号：R656.64[医药卫生—外科学]