胃内镜黏膜下剥离术中使用二氧化碳注气的安全性及有效性研究

Safety and efficacy of carbon dioxide insufflation in gastric endoscopic submucosal dissection

目的该实验旨在研究二氧化碳CO_2作为胃内镜黏膜下剥离术(ESD)中注入气体的安全性及有效性。方法选取2013年1月-2014年12月于中国医科大学附属盛京医院内镜诊治中心,接受胃ESD术治疗的患者80例,40例术中注CO_2气(CO_2组),40例术中注空气(空气组),分别检测患者术前、术中及术后的动脉血CO_2分压(PaCO_2),视觉模拟评分量表(VAS)评分记录每组患者术后1、6及24 h腹痛及腹胀程度,同时记录并发症发生情况。结果两组病例整个研究过程中不同时间段PaCO_2及腹痛评分差异无统计学意义,CO_2组在ESD术后1和6 h的腹胀平均VAS分值较空气组明显降低,并发症的发生率在两组间差异无统计学意义。结论胃ESD术应用CO_2注气安全性良好。CO_2注气能够有效减轻患者术后腹胀症状,改善术后恢复质量。

Objective To evaluate the safety and efficacy of carbon dioxide（CO_2） used as an alternative to air in the gastric endoscopic submucosal dissection（ESD）. Methods 80 cases underwent ESD treatment were randomly assigned to two groups, 40 cases in CO_2 group and 40 in air group. Arterial blood CO_2 partial pressure was measured preoperative, intraoperative and postoperative respectively. Visual analog scale（VAS） was used to record patients the degree of abdominal pain and distention at 1 h, 6 h and 24 h after operation in each group. The incidence of complications were evaluated. Regular follow up were scheduled in all the patients. Results There was no significant difference in degree of abdominal pain score and the CO_2 partial pressure between the two groups. The abdominal distension scores of CO_2 group were significant lower than air group at 1 h, 6 h after the ESD procedure. There were no statistically significant difference in the incidence rate of complications. Conclusion The utilization of CO_2 in gas insufflation during gastric ESD is safe. CO_2 insufflation can significant reduce the postoperative abdominal distension and improve the quality of postoperative recovery.