两种黏膜切开刀在食管病变内镜黏膜下剥离术中的有效性及安全性比较

Comparison of efficiency and safety of two kinds of mucosal resection knife in endoscopy submucosal dissection for esophageal lesions

目的比较单极内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)电刀(简称T刀)与Dual刀在ESD治疗食管病变中的有效性及安全性。方法纳入2018年6月—2019年1月期间就诊于苏州大学附属第一医院、诊断为食管病变且行ESD治疗的59例患者,采用随机数字表法分为Dual刀组(30例)及T刀组(29例)。比较两组操作时间、切除速度、完全切除率以及并发症发生率等情况。结果T刀组与Dual刀组患者在性别、年龄、合并症等方面差异均无统计学意义(P>0.05)。T刀组、Dual刀组的手术时间分别为(57.86±24.62)min和(66.28±29.48)min,差异有统计学意义(t=1.189,P=0.024);切除速度分别为(22.80±7.31)mm2/min和(16.20±7.24)mm2/min,差异有统计学意义(t=3.484,P=0.001);病灶完全切除率分别为86.2%(25/29)和86.7%(26/30),差异无统计学意义(χ2=0.108,P=0.742)。T刀组出现并发症2例(6.9%),Dual刀组并发症共5例(16.7%),两组并发症发生率比较差异无统计学意义(χ2=0.574,P=0.449)。两组均未见术后穿孔、出血情况。结论在食管病变ESD中,T刀相较于Dual刀能缩短手术时间,提高切除速度,安全性、有效性具有一定优势。

Objective To compare the efficiency and safety of T knife and Dual knife in endoscopic submucosal dissection (ESD) in the treatment of esophageal lesios.Methods A total of 59 hospitalized patients with esophageal lesions who underwent ESD in the First Affiliated Hospital of Soochow University from June 2018 to January 2019 were enrolled in the study, and the patients were randomly divided into T knife group (n=29) and Dual knife group (n=30). The operation time, resection speed, complete resection rate, and complications of the two groups were compared.Results There were no significant differences in gender, age and comorbidity between the T knife group and the Dual knife group (all P > 0.05). The operation time of T knife group and Dual knife group was 57.86±24.62 min and 66.28±29.48 min, respectively, and the difference was statistically significant (t=1.189, P=0.024). The resection speed of the two groups was 22.80±7.31 mm2/min and 16.20±7.24 mm2/min, respectively, with significant difference (t=3.484, P=0.001). The complete resection rate of the two group was 86.2% (25/29) and 86.7% (26/30), respectively, with no significant difference (χ2 =0.108, P=0.742). There were 2 (6.9%) cases of complications in the T knife group, while 5 (16.7%) cases in the Dual knife group, the incidence of complications was no significant difference (χ2=0.574, P=0.449). There was no perforation or bleeding in the both groups.ConclusionIn the treatment of esophageal lesions, T knife in ESD has the advantages of short operation time and high resection speed compared with Dual knife, and is worthy of clinical application.