两种圈套器改良牵引法辅助内镜黏膜下剥离术治疗上消化道早癌和黏膜下肿瘤的临床对比研究

Comparison of the effectiveness of two modified snare traction methods in endoscopic submucosal dissection of early upper gastrointestinal cancer and submucosal tumor

摘要:

目的 研究体外圈套器改良牵引辅助技术在内镜黏膜下剥离术（ESD）治疗上消化道早癌和黏膜下肿瘤中的应用价值，并对比两种圈套器牵引法的应用效果。方法 回顾性分析该院接受ESD治疗的上消化道早癌和黏膜下肿瘤患者72例，A组为传统ESD方法治疗组，B组为粗圈套器圈套牵引组，C组为细圈套器圈套牵引组。比较3组病变直径、手术平均时间、止血夹脱离次数、黏膜下补充注射量、一次完整切除率、并发症和随访情况。结果 72例患者均成功完成ESD术，3组病灶直径、术中明显出血和迟发性出血比较，差异均无统计学意义（P > 0.05）；C组手术平均时间和黏膜下补充注射量明显少于A组，两组比较，差异有统计学意义（P < 0.05）；C组（100.00%）一次完整切除率高于B组和A组，3组比较，差异有统计学意义（P < 0.05）；C组组织夹脱离次数少于B组，两组比较，差异有统计学意义（P < 0.05）。结论 改良圈套器牵引辅助技术能明显缩短操作时间，减少术中黏膜下补充注射量，且具有牵引方向可调节的优点。使用体外细圈套器辅助牵引法，组织夹不易脱离，一次完整切除率高，特别是在上消化道困难ESD术中应用更具优势。

Abstract:

Objective To study the application value of extracorporeal modified snare traction in endoscopic submucosal dissection (ESD) of early upper gastrointestinal cancer and submucosal tumor, and compare the application effect of two modified snare traction methods.Methods Retrospective analysis was performed on 72 patients with early upper gastrointestinal cancer and submucosal tumor treated with ESD. Group A was treated with traditional ESD, group B was treated with thick snare traction, and group C was treated with thin snare traction. The diameter of the lesion, the mean operation time, the number of hemostatic clip detachment, the submucosal injection amount, the rate of complete resection, the complications and the follow-up of the three groups were compared.Results 72 patients were successfully completed ESD, the difference were not statistically significant (P > 0.05) in the lesion diameter, intraoperative bleeding obvious and delayed hemorrhages of three groups; The average operation time, added submucosal injection quantity of C group is significantly less than group A (P < 0.05). A complete resection rate of group C (100.00%) was higher than that of group B and group A, the difference was statistically significant (P < 0.05); Number of hemostatic clip detachment of group C was less than group B, the differences was statistically significant (P < 0.05).Conclusion The modified snare traction-assisted technique can significantly shorten the operation time of ESD in the upper gastrointestinal tract, reduce the intraoperative submucosal supplementary injection, and has the advantage of adjustable traction direction. Using external thin snare to assist traction, the hemostatic clip is not easy to be detached, and the complete removal rate is high, especially for the application of difficult ESD in the upper digestive tract.