改良型圈套器在内镜黏膜下剥离术切除胃和食管上皮内瘤变中的疗效评价

Efficacy evaluation of modified snare in the removal of gastric and esophageal intraepithelial neoplasia by submucosal dissection

摘要:

探讨改良型圈套器行内镜黏膜下剥离术（ESD）切除胃和食管上皮内瘤变的安全性和有效性。方法?回顾性分析2014年12月－2018年1月采用改良型圈套器或Dual刀完成ESD切除胃和食管上皮内瘤变患者的临床资料，分别从手术成功率、病灶整块切除率、手术时间、术中出血量、术后病理、术后并发症和一次性耗材费用等方面进行比较。结果?共40例患者40处病灶入选并完成ESD术，其中20例病例采用改良型圈套器行ESD术（实验组），另20例病灶采用Dual刀完成ESD术（经典对照组）。两组手术成功率均为100.0%；两组术中出血量和术后病灶长径比较，差异均无统计学意义（P =0.342，P =0.576）；实验组和对照组病灶整体切除率分别为95.0%和100.0%；术后两组患者均无明显出血及穿孔等并发症；实验组术前1例高级别瘤变患者，术后病理示鳞状细胞癌（转外科手术）；对照组术前1例高级别瘤变患者，术后病理提示食管原位癌（病灶距离切缘及基底部>0.1 cm），两组比较，差异无统计学意义（P =0.523）；实验组与对照组手术时间分别为（72.3±13.4）和（55.2±16.4）min，差异有统计学意义（P =0.032）；一次性耗材费用比较：实验组改良型圈套器的价格远远低于对照组中的Dual刀价格。结论?改良型“单丝小头”圈套器能够安全、有效地完成ESD术，顺利切除胃和食管上皮内瘤变，与经典的Dual刀相比，除手术时间长外，其余指标从统计学意义上看均无明显差异。将在临床上物美价廉的改良型圈套器用于ESD切除胃和食管上皮内瘤变及黏膜下肿瘤中值得临床推广。

Abstract:

To investigate the safety and efficacy of endoscopic submucosal dissection (ESD) in the removal of gastric and esophageal intraepithelial neoplasia. Methods A retrospective study of the clinical data of patients with gastric or esophageal intraepithelial neoplasia with ESD resection using modified snare or Dual scalpel from December 2014 to January 2018, respectively, from surgical success rate, lesion resection rate, surgery time, intraoperative blood loss, postoperative pathology, postoperative complications, and cost of disposable consumables were compared. Results 40 cases were enrolled in and completed ESD. 20 cases were treated with modified traps for ESD (experimental group), and 20 cases with Dual scalpel for ESD (classic control group). The success rate of surgery was 100.0% in both groups. The intraoperative blood loss and the long-term diameter of the postoperative lesions were respectively not significant (P = 0.342, 0.576). The difference was not statistically significant. In terms of rate, the overall resection rate of the lesions in the experimental group and the control group were 95.0% and 100.0% respectively. There were no complications such as bleeding and perforation in the two groups. The preoperative and postoperative pathology were compared before surgery. One case of high-grade neoplasia in treatment group, squamous cell carcinoma was showed postoperative pathology (performing surgery), one case of high-grade neoplasia pre-operation in control group, carcinoma in situ of esophageal was showed postoperative pathology (lesion distance from the incisor margin and basement > 0.1 cm), the difference was not statistically significant (P = 0.523). The operation time of the difference was statistically significant (P = 0.032), operation in the experimental group and the irradiation group were (72.3 ± 13.4) min, (55.2 ± 16.4) min; the price of the disposable consumables in the experimental group was much lower than the Dual scalpel of the control group. Conclusion The modified “monofilament small head” snare can complete ESD resection of gastroesophageal epithelial neoplasia safely and effectively. Compared with the classic Dual scalpel, except for a slightly longer operation time, the other comparisons are statistically significant. There is no significant difference in appearance. It provides an important clinical and theoretical basis for the promotion of clinically ESD resection of gastric, esophageal intraepithelial neoplasia and submucosal tumors.