双腔双弯内镜在胃角内镜黏膜下剥离术中的应用价值

Application value of dual channel dual curved endoscope in the endoscopic submucosal dissection for gastric angle mucosal lesions

目的探讨双腔双弯内镜在内镜黏膜下剥离术(ESD)治疗胃角黏膜病变中的应用价值。方法采用描述性病例系列研究方法,回顾性分析2016年10月至2018年8月间复旦大学附属中山医院内镜中心全程使用双腔双弯内镜对胃角黏膜病变行ESD治疗的所有病例资料。病例入选标准:(1)术前通过胃镜检查明确病变位于胃角;(2)CT检查明确无远处转移;(3)病理活检明确为癌前病变或早期胃癌,肿瘤无黏膜下浸润;(4)手术全程均由同一位主刀医师(有约2 000例ESD手术经验)操作。排除既往有胃角ESD手术史、手术期间合并有其他严重疾病者。手术操作均采用双腔双弯内镜以及其他常规内镜手术器械。观察肿瘤完整切除率和病理结果、术中术后并发症,以及手术时间、住院时间。随访指标包括肿瘤残留、局部复发和异时病灶发生情况。结果共计20例患者,其中男性14例,女性6例,年龄37~75(平均55.6)岁,切除肿瘤标本最大径1.2~5.5(平均2.9)cm,手术时间50~120(平均85.8)min,住院时间3~7(平均5.1)d。标本完整切除率100%,所有病例手术过程中均无穿孔,无迟发性穿孔或出血。术后病理均为完全治愈切除或相对治愈切除。经过8~30(平均18.5)个月的随访后,所有病例创面愈合良好,无肿瘤残留或局部复发。结论使用双腔双弯内镜应用于ESD治疗胃角黏膜病变,能够完整切除病灶,避免手术并发症的发生,远期疗效良好。

Objective To evaluate the clinical value of dual channel dual curved endoscope in the endoscopic submucosal dissection (ESD) for gastric angle mucosal lesions. Methods A descriptive cohort study was carried out. Clinicopathological data of 20 cases with gastric angle mucosal lesions undergoing ESD by dual channel dual curved endoscope in our center from October 2016 to August 2018 were collected and analyzed retrospectively. Inclusion criteria:(1) the lesion was located in the gastric angle confirmed by gastroscopy before ESD.(2) CT examination showed no distant metastasis.(3) pathological biopsy confirmed precancerous lesion or early cancerous lesion without submucosal invasion.(4) the whole operation was performed by the same endoscopist with ESD experience of about 2000 cases. Patients with previous ESD history of gastric angle and other serious diseases were excluded. The dual channel dual curved endoscopy (Olympus,GIF-2TQ260M) and other conventional endoscopic surgical instruments were used in all the cases. Complete tumor resection rate,pathological results,intraoperative and postoperative complications,operation time and hospitalization time were observed. Follow - up parameters included residual tumor,local recurrence and heterogeneous lesion. Results Of 20 patients,14 were male and 6 were female with an average of 55.6 years (range,37 to 75). All the tumors located in gastric angle. Specimen size ranged from 1.2 to 5.5 (average 2.9) cm. Operation time ranged from 50 to 120 (average 85.8) minutes. Hospital stay ranged from 3 to 7 (average 5.1) days. The en bloc excision was performed successfully in all 20 cases. There was no perforation or bleeding during or after operation. Pathological results showed curative or nearly curative resection stage in all the cases. No tumor residual or recurrence was found during follow-up for 8 to 30 (average 18.5) months. Conclusion Dual channel dual curved endoscope can provide good vision and easy control in removing the lesion completely and avoiding complications during the ESD procedure in gastric angle mucosal lesions with good long-term efficacy.