维生素C在食管碘染色内镜黏膜下剥离术中的应用

Application of vitamin C in endoscopic submucosal dissection of esophageal iodine staining

摘要:

目的 探讨维生素C在食管碘染色内镜黏膜下剥离术（ESD）中的临床应用效果。方法 回顾性分析重庆大学附属涪陵医院2020年1月－2021年9月68例食管癌前病变患者的临床资料，均在碘染色后行ESD。术前胃内注入0.4%维生素C生理盐水40 mL，再行食管碘染色，碘染色完成病变标记后，用0.4%维生素C生理盐水20 mL冲洗食管，再用生理盐水冲洗，然后行手术的患者为A组（n = 31）；食管碘染色完成病变范围标记，常规生理盐水冲洗碘液，然后行手术的患者为B组（n = 37）。分析两组患者手术时间、标本横径、咽喉部不适、胸腹部疼痛评分、镇痛药物使用率和术后胃体内镜下黏膜情况。结果 A组和B组患者咽喉部不适、手术时间和标本横径比较，差异均无统计学意义（P > 0.05）；A组和B组胸腹部疼痛评分分别为（1.29±0.59）和（3.54±1.26）分，两组患者比较，差异有统计学意义（t = 9.13，P = 0.001）；A组镇痛药使用率为0.00%（0/31），与B组镇痛药使用率13.51%（5/37）比较，差异有统计学意义（P = 0.042）；两组患者内镜下胃体黏膜情况变化比较，差异有统计学意义（χ2 = 26.15，P = 0.000）。结论 食管碘染色ESD术前胃底注入维生素C生理盐水，碘染色完成病变标记后，再予以维生素C生理盐水冲洗，可明显减轻患者术后疼痛，增加患者舒适感，值得在临床推广应用。

Abstract:

Objective To investigate the clinical effect of vitamin C in patients underwent endoscopic submucosal dissection (ESD) after esophageal iodine staining.Methods 68 patients with esophageal precancerous lesions who underwent ESD after iodine staining from January 2020 to September 2021 were analyzed retrospectively. Before operation, 0.4% vitamin C saline 40 mL was injected into the stomach, and the esophagus was stained with iodine. After the lesions were marked by iodine staining, the esophagus was rinsed with 0.4% vitamin C saline 20 mL and then rinsed with normal saline, and then the patients were divided into group A (n = 31). Esophageal iodine staining was used to mark the lesion area, and the patients underwent operation after routine saline iodine washing solution were divided into group B (n = 37). The operation time, transverse diameter of specimen, throat discomfort, chest and abdominal pain score and the use of analgesics were analyzed.Results There was no significant difference in pharynx and throat discomfort, operation time and transverse diameter between the two groups. The scores of thoracic and abdominal pain in group A and group B were (1.29 ± 0.59) and (3.54 ± 1.26) respectively, and the difference was statistically significant (t = 9.13, P = 0.001), and the use of analgesics was 0 in group A and 5 in group B, and utilization rate of group A (0.00%) compared with group B (13.51%), the difference was statistically significant (P = 0.042). Comparison of gastric fundus mucosa, the difference was statistically significant (χ2 = 26.15, P = 0.000).Conclusion Vitamin C saline is injected into gastric fundus before esophagus ESD and iodine staining, and then rinsed with vitamin C saline after iodine staining. This innovative method can significantly reduce postoperative pain and increase patient comfort, and can be popularized in clinical application.