新型提拉夹辅助牵引在早期结直肠癌及其癌前病变内镜黏膜下剥离术中的应用价值

Application value of a new type of lifting clip-assisted traction in endoscopic submucosal dissection for early colorectal cancer and its precancerous lesions

目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期结直肠癌及其癌前病变过程中采用新型提拉夹辅助牵引的临床效果及安全性。方法2021年3月—7月,在上海市第十人民医院消化内镜中心接受ESD治疗的42例结直肠病变患者纳入回顾性研究,其中19例采用新型提拉夹辅助纳入观察组,其余23例未采用辅助方式纳入对照组,对比分析2组手术时间、住院时间、住院费用以及并发症发生情况。结果42例均成功行ESD治疗。观察组手术时间明显短于对照组[31.00(21.00,58.00)min比60.00(30.00,75.00)min,Z=-2.04,P=0.04],术后住院时间明显短于对照组[2.00(1.00,2.00)d比2.00(2.00,3.00)d,Z=-1.99,P=0.04],住院费用少于对照组,但差异无统计学意义[(19331.42±3481.20)元比(19802.40±2548.50)元,t=-0.49,P=0.63]。2组均未发生术中穿孔。观察组和对照组术中出血量组间差异无统计学意义[0.00(0.00,5.00)mL比3.00(0.00,7.00)mL,Z=-1.42,P=0.16]。观察组术后腹痛1例,对照组术后腹痛2例、发热1例,术后并发症总体发生率组间差异无统计学意义[5.3%(1/19)比13.0%(3/23),χ^(2)=0.73,P=0.39]。结论新型提拉夹辅助结直肠ESD安全、有效,能显著缩短ESD手术时间和患者术后住院天数,且不会额外增加患者经济负担。

Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection(ESD)for early colorectal cancer and its precancerous lesions by using novel lifting clip-assisted traction.Methods From March to July 2021,42 patients with colorectal lesions who received ESD at the Digestive Endoscopy Center of Shanghai Tenth People's Hospital were included in the retrospective study.Nineteen patients were enrolled as the observation group using the novel lifting clip,and 23 others in the control group without the help of an auxiliary method.The operation time,the hospital stay,hospital expenses and the incidence of complications of the two groups were compared.Results All 42 patients successfully received ESD.The operation time of the observation group was significantly shorter than that of the control group[31.00(21.00,58.00)min VS 60.00(30.00,75.00)min,Z=-2.04,P=0.04].The postoperative hospital stay of the observation group was significantly shorter than that of the control group[2.00(1.00,2.00)d VS 2.00(2.00,3.00)d,Z=-1.99,P=0.04].The hospital cost was lower than that of the control group,but the difference was not statistically significant(19331.42±3481.20 yuan VS 19802.40±2548.50 yuan,t=-0.49,P=0.63).No intraoperative perforation occurred in either group.There was no significant difference in intraoperative blood loss between the observation group and the control group[0.00(0.00,5.00)mL VS 3.00(0.00,7.00)mL,Z=-1.42,P=0.16].There was 1 case of postoperative abdominal pain in the observation group,2 cases of postoperative abdominal pain and 1 case of fever in the control group.There was no significant difference in the overall incidence of postoperative complications between the observation group and the control group[5.3%(1/19)VS 13.0%(3/23),χ^(2)=0.73,P=0.39].Conclusion The novel lifting clip-assisted colorectal ESD is safe and effective,which can significantly shorten the ESD operation time and postoperative hospital stay without increasing the economic burden of patients.