金属夹造袋牵引法辅助内镜黏膜下剥离术治疗结直肠肿瘤的临床效果

Efficacy of endoscopic submucosal dissection assisted by metal-clip pocket creation traction for colorectal tumors

目的分析金属夹造袋牵引法辅助内镜黏膜下剥离术(ESD)治疗结直肠肿瘤的临床效果。方法选取2019年1月~2022年12月该院进行结直肠ESD治疗的结直肠肿瘤244例患者作为研究对象。根据ESD术中是否实施金属夹造袋牵引法,将患者分为金属夹牵引组(M-ESD,n=75)和无牵引组(N-ESD,n=169)。采用倾向性评分匹配法筛选患者,以一般临床资料为协变量进行匹配。比较匹配后两组患者的手术时间、手术切除结果指标、不良事件发生率和病理组织学诊断指标。结果M-ESD组的手术时间短于N-ESD组(分别为20.0[15.0,30.0]min和30[20.0,45.0]min,P=0.008)。M-ESD组与N-ESD组的整块切除率(100%vs98.6%)、完全切除率(97.3%vs96%)以及根治切除率(97.3%vs96%)均无统计学差异(P>0.05)。M-ESD和N-ESD组的不良事件发生率较低且无统计学差异(P>0.05)。结论尽管与无牵引组相比,金属夹牵引组在手术切除率和不良事件发生率无明显差异,但是使用金属夹造袋牵引法可能具有缩短ESD手术时间的临床作用。

Objective To evaluate the clinical efficacy of endoscopic submucosal dissection(ESD)assisted by metal-clip pocket-creation traction for treatment of colorectal tumors.Methods We retrospectively analyzed the clinical data of 244 patients with colorectal tumors undergoing colorectal ESD treatment between January,2019 and December,2022,including 169 patients receiving ESD without metal-clip pocket-creation traction(N-ESD group)and 75 with traction-assisted ESD(M-ESD group).Propensity score matching was used to screen the patients using general clinical data as the covariates for matching.Operative time,surgical resection outcome indicators,incidence of adverse events,and histopathological diagnosis indicators were compared between the two groups of patients after matching.Results The median operative time was significantly shorter in M-ESD group than in N-ESD group(20.0[15.0,30.0]vs 30[20.0,45.0]min,P=0.008).No significant difference was found in the en bloc resection rate(100%vs 98.6%),complete resection rate(97.3%vs 96%)and radical resection rate(97.3%vs 96%)between the two groups(P>0.05).The incidence of adverse events was low in both groups and showed no significant difference between them(P>0.05).Conclusion In patients with colorectal tumors,the use of metal-clip pocket-creation traction can shorten the operative time of ESD although it does not significantly reduce the surgical resection rate or incidence of adverse events.