牙线牵引辅助技术在内镜黏膜下剥离术治疗早期直肠癌及癌前病变中的临床效果分析

Clinical Effect of Dental Floss Traction Assisted Technique in Endoscopic Submucosal Dissection for Early Rectal Cancer and Precancerous Lesions

目的 研究牙线牵引辅助技术在内镜黏膜下剥离术(ESD)治疗早期直肠癌及癌前病变中的临床效果。方法 选择80例直肠癌及癌前病变患者,按随机数字表法分为2组,各40例。对照组行ESD治疗,研究组行牙线牵引辅助ESD治疗,观察至患者出院。对比两组病灶切除效果、围术期指标、胃肠道功能、术后并发症发生率。结果 研究组整块切除率(92.50%)、完全切除率(100.00%)较对照组(75.00%、85.00%)均更高,不完全切除率(0)较对照组(15.00%)更低,差异有统计学意义(P<0.05);研究组手术操作时间、术后住院时间较对照组均更短,术中黏膜下注射液注射量、术中出血量较对照组均更少,差异有统计学意义(P<0.05);与术前对比,术后3 d两组血清胃动素(MTL)水平均降低,但研究组明显高于对照组,差异有统计学意义(P<0.05);与术前对比,术后3 d两组血清D-乳酸(D-LA)水平均增高,但研究组明显低于对照组,差异有统计学意义(P<0.05);研究组术后并发症总发生率(5.00%)略低于对照组(12.50%),但差异无统计学意义(P>0.05)。结论 牙线牵引辅助技术在ESD治疗早期直肠癌及癌前病变中应用价值高,能提升病灶切除效果,缩短手术操作时间和术后恢复时间,减少术中出血,减轻手术操作对患者胃肠道功能造成的损害,且安全性高,可于临床推广。

Objective Objective To study the clinical effect of dental floss traction assisted technique in endoscopic submucosal dissection(ESD)for early rectal cancer and precancerous lesions.Methods 80 patients with rectal cancer and precancerous lesions were randomly divided into 2 groups,40 patients each.The control group was treated with ESD,and the study group was treated with dental floss traction assisted ESD.The patients were observed until discharge.The curative effect,perioperative index,gastrointestinal function and postoperative complication rate of the 2 groups were compared.Results The total resection rate(92.50%)and complete resection rate(100.00%)in the study group were higher than those in the control group(75.00%and 85.00%).The incomplete resection rate(0)was lower than that in the control group(15.00%).The difference was statistically significant(P<0.05);The operation time and postoperative hospitalization time of the study group were shorter than those of the control group,and the amount of submucosal injection and intraoperative bleeding were less than those of the control group(P<0.05);Compared with that before operation,the serum motilin(MTL)level of the two groups decreased at 3 days after operation,but the level of the study group was significantly higher than that of the control group(P<0.05);Compared with that before operation,the level of serum D-lactate(d-la)in the 2 groups increased at 3 days after operation,but the level in the study group was significantly lower than that in the control group(P<0.05);The total incidence of postoperative complications in the study group(5.00%)was slightly lower than that in the control group(12.50%),but the difference was not statistically significant(P>0.05).Conclusion Floss traction assisted technique has high application value in ESD treatment of early rectal cancer and precancerous lesions.It can improve the effect of lesion resection,shorten the operation time and postoperative recovery time,reduce intraoperative bleeding,and reduce the damage caused by the operation to the gastrointestinal function of patients.It has high safety and can be popularized in clinic.