橡皮圈组织夹内牵引辅助在内镜黏膜下剥离术治疗结直肠病变中的应用(含视频)

Application of rubber band and clip facilitated endoscopic submucosal dissection for colorectal neoplasms(with video)

目的评价橡皮圈组织夹内牵引辅助内镜黏膜下剥离术(rubber band and clip facilitated endoscopic submucosal dissection,RAC-ESD)治疗结直肠病变的安全性和有效性。方法采用回顾性队列研究方法,分析2018年9月—2019年8月间在北京大学第一医院内镜中心接受内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗,符合纳入和排除标准的115例结直肠病变患者,依照ESD手术方式分为RAC-ESD组(n=34)及传统ESD组(n=81),比较两组间手术时间、单位时间切除面积、整块切除率、完全切除率、治愈性切除率、并发症发生率及肿瘤复发率等指标。结果RAC-ESD组中位标本面积6-32(7-53)cm^(2),中位手术时间40-0(55-0)min,中位单位时间切除面积0-14(0-20)cm^(2)/min。传统ESD组中位标本面积4-71(5-02)cm^(2),中位手术时间50-0(50-0)min,中位单位时间切除面积0-09(0-07)cm^(2)/min。RAC-ESD组标本面积略大于传统ESD组,手术时间略短于传统ESD组,但差异均无统计学意义(P均>0-05)。RAC-ESD组单位时间切除面积明显大于传统ESD组(P=0-008)。RAC-ESD组整块切除率、完全切除率及治愈性切除率分别为100-0%(34/34)、100-0%(34/34)及97-1%(33/34),传统ESD组分别为100-0%(81/81)、96-3%(78/81)和91-4%(74/81)。两组均无操作相关并发症发生。经过(10-0±5-5)个月随访,两组均无局部复发。结论RAC-ESD治疗结直肠病变可提高手术效率,安全有效。

Objective To evaluate the safety and efficacy of rubber band and clip facilitated endoscopic submucosal dissection(RAC-ESD)for colorectal neoplasms.Methods A retrospective cohort study was performed.Clinical data of 115 patients with colorectal neoplasm receiving ESD from September 2018 to August 2019 were retrospectively analyzed.Thirty-four patients received RAC-ESD treatment(RAC-ESD group)and 81 received conventional ESD treatment(conventional ESD group).The procedure time,the dissected area per minute during ESD,en bloc resection rate,complete resection rate,curative resection rate,complication occurence and recurrence rate were compared between the two groups.Results The median specimen area of RAC-ESD group was 6-32(7-53)cm^(2),and the median procedure time was 40-0(55-0)min.The mean dissected area per minute was 0-14(0-20)cm^(2)/min.While in conventional ESD group,the median specimen area was 4-71(5-02)cm^(2),the median procedure time was 50-0(50-0)min and the mean dissected area per minute was 0-09(0-07)cm^(2)/min.The median specimen area of RAC-ESD group was slightly larger and the median procedure time was slightly shorter than those of conventional ESD group,but neither was significantly different(both P>0.05).The median dissected area per minute of RAC-ESD group was significantly larger than that of the conventional ESD group(P=0-008).The en bloc resection rate,complete resection rate and curative resection rate of RAC-ESD group were 100-0%(34/34),100-0%(34/34)and 97-1%(33/34),while those of the conventional ESD group were 100.0%(81/81),96.3%(78/81)and 91.4%(74/81),respectively.There was no ESD-related complication in either group.After 10-0±5-5 months of follow-up,there was no local recurrence in both groups.Conclusion RAC-ESD may increase resection efficacy with safety.