牙线牵引辅助技术在内镜黏膜下剥离早期直肠癌及癌前病变中的应用研究

Application of dental floss traction assisted technique in endoscopic submucosal dissection for early rectal cancer and precancerous lesions

摘要:

研究牙线牵引辅助技术在内镜黏膜下剥离术（ESD）治疗早期直肠癌及癌前病变中的应用价值和安全性。方法 收集2014年9月-2017年6月湖北省肿瘤医院内镜科采用ESD治疗的57例早期直肠癌及癌前病变患者，随机数字表法分为牙线牵引组（n =28）和常规组（n =29），对比分析两组平均手术时间、黏膜下补充注射量及补充注射次数、完整切除率、R0切除率、并发症情况及随访结果。结果 57例均成功施行ESD治疗。牵引组的平均手术时间、黏膜下补充注射量及补充注射次数均明显少于常规组[（55.11±10.44）vs（74.72±14.47）min；（5.80±1.80）vs（10.00±5.70）ml；（1.10±0.90）vs（1.70±0.90）次]，两组间在平均手术时间（P =0.000）、黏膜下补充注射量（P =0.001）、黏膜下补充注射次数（P =0.022）上比较，差异均有统计学意义。牵引组及对照组完整切除率及R0切除率均为100.0%。并发症方面牵引组无出血及穿孔发生，常规组发生1例（3.4%）术后迟发性出血，2例（6.9%）术中穿孔，组间差异均无统计学意义（P >0.05）。随访期间两组病例均无复发。结论 牙线牵引辅助技术能显著缩短直肠ESD操作时间，减少术中黏膜下补充注射量及次数，并能确保良好的治疗效果。

Abstract:

Abstract: Objective To investigate the efficacy and safety of dental floss traction assisted technique in endoscopic submucosal dissection (ESD) of early rectal cancer and precancerous lesions. Methods 57 patients recived ESD for early colorectal cancer and precancerous lesions from September 2014 to June 2017 were randomly divided into dental floss traction group (n = 28) and routine group (n = 29). To compare the average operation time, the amount of supplementary submucosal injection, and frequency of supplementary submucosal injection, complete resection rate, R0 resection rate, complications and follow-up results of the two groups. Results All 57 cases were treated with ESD successfully. The average operation time, the amount of supplementary submucosal injection and the frequency of injection were significantly less in the dental floss traction group than in the conventional group [(55.11 ± 10.44) vs (74.72 ± 14.47) min; (5.80 ± 1.80) vs (10.00 ± 5.70) ml; frequency (1.10 ± 0.90) vs (1.70 ± 0.90)]. The average operation time (P = 0.000), the amount of supplementary submucosal injection (P = 0.001) and the frequency of supplementary submucosal injection (P = 0.022) were significantly different between the two groups.The complete resection rate and R0 resection rate were 100.0% in both groups. There was no bleeding or perforation in the dental floss traction group, and 1 cases (3.4%) in the conventional group had delayed bleeding after operation, and 2 cases (6.9%) perforation occurred during the operation, and there was no significant difference between the two groups (P > 0.05). No recurrence was found in the two groups during follow-up period. Conclusions Dental floss traction assisted technique can significantly shorten the operation time of ESD, reduce the amount and frequency of supplementary submucosal injection and ensure good therapeutic effect for early colorectal cancer and precancerous lesions.