带线钛夹牵引技术在直肠乙状结肠巨大侧向发育型肿瘤内镜黏膜下剥离术中的应用价值

Application of traction with titanium clips in endoscopic submucosal dissection for large laterally spreading tumor in rectum and sigmoid colon

摘要:

目的 研究带线钛夹牵引技术在直肠乙状结肠巨大侧向发育型肿瘤（LST）内镜黏膜下剥离术（ESD）中的临床疗效。方法 回顾性分析2018年1月－2022年6月该院67例行ESD治疗的直径 ≥ 3 cm的直肠乙状结肠LST患者的临床资料。根据是否使用带线钛夹牵引，将患者分为A组（带线钛夹牵引组，n = 32）和B组（传统ESD组，n = 35）。比较两组患者病灶大小、切除总时间、黏膜下剥离时间、黏膜下剥离速率、黏膜下补充注射次数、病变整块切除率、完整切除率（R0切除率）、治愈性切除率和并发症发生率等。结果 两组患者镜下形态均以颗粒型-结节混合型（LST-G-M）多见，术后病理均以绒毛状腺瘤为主。两组患者病变整块切除率、R0切除率和并发症发生率比较，差异均无统计学意义（P > 0.05）。A组病灶平均面积为（13.6±8.4）cm²，明显大于B组的（9.3±4.7）cm²，A组切除总时间为（42.3±10.3）min，明显短于B组的（47.9±10.1）min，A组黏膜下剥离时间为（30.7±8.2）min，明显短于B组的（36.1±7.6）min，A组黏膜下补充注射次数为（2.7±1.1）次，明显少于B组的（3.5±1.2）次，A组单位时间剥离速率为（0.4±0.2）cm²/min，明显快于B组的（0.2±0.1）cm²/min，差异均有统计学意义（P < 0.05）。结论 带线钛夹牵引技术可为直肠乙状结肠巨大LST的ESD治疗提供更清晰的视野，且操作简单，能提高单位时间剥离速率，具有较好的临床应用价值。

Abstract:

Objective To investigate the advantages and efficacy of traction with titanium clips in endoscopic submucosal dissection (ESD) for large laterally spreading tumor (LST) in rectum and sigmoid colon.Methods 67 patients with large sigmoid or rectal LST underwent ESD from January 2018 to June 2022 were analyzed retrospectively, including 32 patients in Group A and 35 patients in Group B. Group A was treated with clip-line traction and group B was treated with traditional ESD. The size of lesion, the total operation time, the submucosal dissection time, submucosal dissection rate, submucosal injection number, en bloc resection rate, R0 resection rate, curative resection rate and complications of the two groups were compared.Results LST-G-M was the most common type and villous adenoma was the main pathology in both groups. There were no differences in en bloc resection rate, R0 resection rate and incidence of complications between the two groups. The average size of group A was (13.6 ± 8.4) cm², significantly larger than that in group B (9.3 ± 4.7) cm², the total operation time was (42.3 ± 10.3) min in group A, significantly shorter than that in group B (47.9 ± 10.1) min, submucosal dissection time was (30.7 ± 8.2) min in group A, significantly shorter than that in group B (36.1 ± 7.6) min, submucosal injection number was (2.7 ± 1.1) times in group A, significantly less than that in group B (3.5 ± 1.2) times, submucosal dissection rate was (0.4 ± 0.2) cm²/min in group A, significantly faster than that in group B (0.2 ± 0.1) cm²/min, the differences were statistically significant (P < 0.05).Conclusion Compared with traditional ESD, clip-line traction can provide a better surgical field and more effective dissection for large LST in rectum and sigmoid colon.