二氧化碳灌注在内镜黏膜下剥离术治疗结直肠肿物中的临床应用

Clinical application of carbon dioxide perfusion in endoscopic submucosal dissection in treatment of colorectal masses

摘要:

目的 探讨CO₂作为灌注气体在内镜黏膜下剥离术（ESD）治疗结直肠肿物中的有效性和安全性。方法 选取在东莞市人民医院住院并行ESD治疗结直肠肿物的患者42例，采用随机数字法分为空气组（21例）和CO₂组（21例），灌注气体分别采用空气和CO₂，记录每组患者ESD成功率、操作时间、出血和穿孔等并发症发生情况；记录术前、术中和术后心率（HR）、平均动脉压（MAP）、经皮动脉血氧饱和度（SpO₂）和经皮二氧化碳分压（PetCO₂）的变化；采用视觉模拟量表（VAS）评估术中（到达回盲部）、手术结束时、术后1 h、术后6 h和术后24 h患者的腹痛程度。结果 CO₂组术中、手术结束时、术后1 h、术后6 h和术后24 h腹痛评分明显低于空气组（P < 0.05）。两组患者术前、术中和术后HR、MAP、SpO₂、PetCO₂和并发症发生率比较，差异均无统计学意义（P > 0.05）。结论 CO₂作为结直肠肿物ESD术中灌注气体较空气安全性更高，能明显减轻患者腹部不适感。

Abstract:

Objective To assess the efficacy and safety of carbon dioxide as insufflation gas in the endoscopic submucosal dissection (ESD) of the colorectal tumors.Methods 42 patients receiving ESD for the colorectal tumors were selected and randomly divided into air group (21 cases) and CO₂ group (21 cases). Air and CO₂ were used to insufflation gas, and the success rate, operation time, bleeding, perforation and other complications of ESD were recorded in each group. Changes of heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO₂) and transcutaneous carbon dioxide resolution partial pressure (PetCO₂) preoperation, intraoperation and postoperation were recorded. VAS scales were used to assess the degree of abdominal pain in patients during the operation (reaching the ileocecal part), at the end of the operation, and 1, 6, and 24 h after the operation.Results The abdominal pain score of the CO₂ group was significantly lower than that in air group at different time points (P < 0.05). There were no significant differences in HR, MAP, SpO₂ , PetCO₂ and the complication rate between the two groups before, during and after operation (P > 0.05).Conclusion CO₂ can replace air as a safe insufflation gas in ESD for the colorectal tumors, and can significantly reduce abdominal discomfort.