点胶法在内镜结直肠黏膜下剥离术中的应用

Endoscopic submucosal dissection using the “dropping n-Butyl-2-Cyanoacrylate method”

目的探讨点胶法在ESD中的可行性和安全性。方法选择2016年11月至2017年2月经我院内镜中心行点胶法内镜结直肠ESD的13例患者为研究对象,所有病例均符合消化道ESD治疗适应症。首先对结直肠病变进行染色确认边界,然后进行标记、注射,切边,剥离,当已剥离组织遮挡视野时采用点胶法将其胶黏到远处黏膜,从而暴露黏膜下层,继续完成剥离。结果 15处结直肠病变采用点胶法均实现整块切除,平均操作时间约40.5 min,无迟发性出血与穿孔发生,无其他并发症发生。随访病例创面愈合良好,未见复发。结论点胶法是一种安全可行简便的黏膜下层暴露方法,有助于缩短ESD操作时间、降低并发症发生。

Objective To explore the feasibility of the n-Butyl-2-Cyanoacrylate for endoscopic submucosal dissection（ ESD）. Methods From November 2016 to February 2017,13 patients were enrolled to undergo ESD using the＂dropping n-Butyl-2-Cyanoacrylate method＂in the Endoscopy Center in our hospital.After marking and lifting the lesion,incision and partial dissection were performed. Then,two or five drops of nButyl-2-Cyanoacry late were dropped on the surface of the lesion that was not dissected and far away from the dissected part. Afterwards,the partially resected lesion was pasted onto the surface with n-Butyl-2-Cyanoacrylate. This increased the visualization of the dissection plane,reducing complication rate and procedure time. Result Fifteen lesions were en bloc resected using the ＂dropping n-Butyl-2-Cyanoacrylate method＂with average operation time of 40. 5 min. No delayed bleed or perforation occurred and no other complications were observed. During follow up,the mucosal defects healed well without recurrences. Conclusion ESD using the＂dropping n-Butyl-2-Cyanoacrylate method ＂is safe and easy to perform submucosal dissection,which assists in shortening the operation time and decreasing the complication rate.