自制“8”形牙线内牵引在结直肠内镜黏膜下剥离术中的有效性

doi:10.16138/j.1673-6087.2024.01.10

摘要/Abstract

摘要：

目的: 研究自制“8”形牙线内牵引在结直肠内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）中的有效性。方法: 收集2021年11月至2022年7月期间接受内镜治疗直径≥1 cm的浅表结直肠黏膜病变患者45例，根据手术过程中是否使用牵引，分为牵引辅助ESD组（23例，使用自制“8”形牙线内牵引）和传统ESD组（22例，不使用牵引），分析比较2组手术总时间、黏膜下剥离时间、病变完整切除率、治愈性切除率和不良事件发生率等。结果: 牵引辅助ESD治疗组手术总时间[（58.5±16.2） min比（83.5±22.2）min，P<0.05]、黏膜下剥离时间[（46.3±16.1）min比（68.0±18.8） min，P<0.05]明显少于传统ESD治疗组；2组完整切除率均为100%；传统ESD组的治愈性切除率为90.9%，牵引辅助ESD组的治愈性切除率为91.3%，2组间差异无统计学意义（P>0.05）；2组间出血、穿孔等不良事件的发生率差异无统计学意义（P>0.05）。结论: 与传统ESD相比，采用自制“8”形牙线牵引辅助ESD能够明显减少手术时间，是浅表结直肠病变安全、有效的治疗方法。

关键词: 浅表结直肠病变, 内镜黏膜下剥离术, 内牵引, 手术时间

Abstract:

Objective To investigate the effectiveness of self-made “8” type dental floss traction in endoscopic submucosal dissection (ESD) of the colon and rectum. Methods The patients with superficial colorectal lesions of a diameter of ≥1 cm who underwent endoscopic treatment between November 2021 and July 2022 were enrolled and divided into two groups based on whether traction was used during the surgery, which were traction assisted ESD group (n=23, using self-made “8” dental floss traction) and traditional ESD group (n=22, non-traction). The total surgical time, submucosal detachment time, complete lesion resection rate, curative resection rate, and incidence of adverse events between the two groups were analyzed and compared. Results The total surgical time [(58.5±16.2) min vs (83.5±22.2) min, P<0.05] and submucosal detachment time [(46.3±16.1) min vs (68.0±18.8) min, P<0.05] in the traction assisted ESD treatment group were significantly shorter than those in the traditional ESD treatment group. The complete resection rate in both groups was 100%; the curative resection rate of the traditional ESD group was 90.9%, and the curative resection rate of the traction assisted ESD group was 91.3%，there was no significant difference between the two groups (P>0.05); There was no statistically significant difference in the incidence of adverse events such as bleeding and perforation between the two groups (P>0.05). Conclusions Compared with traditional ESD, using self-made “8” type dental floss traction to assist ESD can significantly reduce surgical time and was a safe and effective treatment method for superficial colorectal lesions.

Key words: Superficial colorectal lesions, Endoscopic submucosal dissection, Internal traction, Surgical time

中图分类号:

R574.63

李晓丽, 李为光, 钱爱华, 蔡文玮. 自制“8”形牙线内牵引在结直肠内镜黏膜下剥离术中的有效性[J]. 内科理论与实践, 2024, 19(01): 57-62.

LI Xiaoli, LI Weiguang, QIAN Aihua, CAI Wenwei. Effectiveness of self-made “8” shaped dental floss traction device in colorectal endoscopic submucosal dissection surgery[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(01): 57-62.

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临床特征	传统ESD组 (n=22)	牵引辅助ESD组 (n=23)	t/χ²	P
年龄(岁)	59.3±12.9	62.9±9.2	1.007	0.287
性别[n(%)]			0.179 5	0.672
男性	13(59.1)	15(59.1)
女性	9(40.9)	8(59.1)
病变位置[n(%)]			1.628 0	0.898
回盲部	2(9.1)	2(8.7)
升结肠	3(13.6)	4(17.4)
横结肠	5(22.7)	6(26.0)
降结肠	4(18.2)	4(17.4)
乙状结肠	3(13.6)	2(8.70)
直肠	5(22.7)	5(21.7)
病变直径[n(%)]			0.179 8	0.671
≤2 cm	7(31.8)	6(26.1)
>2 cm	15(68.2)	17(73.9)
病变形态[n(%)]			0.200 1	0.654
侧向发育型	17(77.3)	19(82.6)
隆起型	5(22.7)	4(17.4)
术前与术后病理符合率	19(86.3)	20(86.9)	0.003	0.953

临床观察指标	传统ESD组(n=22)	牵引辅助ESD组(n=23)	t/χ²	P
手术总时间(min)	83.5±22.2	58.5±16.2	4.359	<0.000 1
黏膜下剥离时间(min)	68.0±18.8	46.3±16.1	4.212	<0.000 1
黏膜下注射液体量(mL)	89.8±29.6	74.6±19.3	2.061	0.045 4
完整切除率[n (%)]	100(100.0)	100(100.0)
治愈性切除率[n (%)]	20(90.9)	21(91.3)	0.002 1	0.962 9
病灶分化程度[n (%)]			0.659 1	0.719 2
低级别上皮内瘤变	8(36.3)	10(43.4)
高级别上皮内瘤变	8(36.3)	9(39.1)
腺癌	6(27.2)	4(17.4)
浸润深度[n(%)]			0.311 3	0.855 9
黏膜层	19(86.4)	19(82.6)
黏膜下层(<1 000 μm)	1(0.5)	2(0.9)
黏膜下层(≥1 000 μm)	2(0.9)	2(0.9)
不良事件[n (%)]
术后出血	1(0.5)	1(0.4)	0.001 0	0.974 3
穿孔	2(0.9)	1(0.4)	0.357 7	0.549 8
住院天数(d)	5.68±1.89	4.91±1.47	1.502	0.140 3