碘伏预防内镜下黏膜剥离术中镜头和透明帽模糊的效果研究

Effect of iodophor in preventing blurring of lens and transparent cap in endoscopic mucosal dissection

目的探讨内镜下黏膜剥离术(ESD)中使用碘伏棉签擦拭镜头和透明帽的效果。方法选取行ESD治疗的484例早期消化道癌和癌前病变患者,随机分为常规组和碘伏组,每组242例。2组术前准备和术中剥离病灶方法相同,碘伏组术前和术中退镜后使用医用棉签浸泡碘伏擦拭镜头和透明帽,常规组使用医用棉签浸泡0.9%氯化钠溶液进行擦拭。比较2组手术时间、术中剥离病灶时间、术中退镜擦拭次数≥2次的比率和ESD并发症发生情况。结果所有患者均一次性成功切除,手术成功率100%。碘伏组ESD手术时间、术中剥离病灶时间均短于常规组,差异有统计学意义(P<0.05)。碘伏组术中退镜擦拭次数≥2次的比率显著低于常规组(P<0.05);2组术中出血、穿孔和感染等并发症发生率比较,差异无统计学意义(P>0.05)。结论ESD术前和术中使用碘伏消毒液擦拭镜头和透明帽,能有效减少术中退镜次数,缩短术中剥离病灶时间和ESD手术时间,是一种保证ESD手术视野清晰的有效方法。

Objective To investigate the effect of iodophor on wiping lens and transparent cap in endoscopic mucosal dissection(ESD).Methods A total of 484 patients with early gastrointestinal cancer and precancerous lesions by ESD treatment were selected and divided into routine group and iodophor group,with 242 cases in each group.The preparation before operation and method of removing focus during operation were the same in both groups.In the iodophor group,the lens and transparent cap were wiped with the medical cotton swab soaked in iodophor before and after the operation,and were wiped with the medical cotton swab soaked in the 0.9%sodium chloride solution in the routine group.The time of operation,the time of removing the focus,ratio of removal and wiping of the mirror two times and above and the incidence of ESD complications were compared between the two groups.Results All the patients were successfully removed at one time,and the success rate of operation was 100%.The time of ESD operation and time of removing focus in iodophor group were significantly shorter than those in routine group(P<0.05).The ratio of frequency of withdrawing mirror and wiping or equalling to and greater than 2 times in iodophor group was significantly lower than that in routine group(P<0.05).There were no significant differences in the incidence rates of bleeding,perforation and infection between the two groups(P>0.05).Conclusion The application of iodophor disinfectant in wiping lens and transparent cap before and during ESD operation can effectively reduce the frequency of withdrawing and wiping mirror,shorten the time of removing focus and time of ESD operation,which is an effective method to ensure clear vision in ESD operation.