夹线牵引辅助内镜黏膜下剥离术治疗食管早癌及癌前病变的效果

Effect of sandwich traction assisted endoscopic submucosal dissection on esophageal early cancer and precancerous lesions

目的分析夹线牵引辅助内镜黏膜下剥离术治疗食管早癌及癌前病变的临床效果。方法选取2018年10月至2021年10月南阳市第二人民医院收治的食管早癌及癌前病变患者80例为研究对象,均行内镜黏膜下剥离术。根据是否采取夹线牵引辅助分为对照组与观察组,40例未进行夹线牵引辅助治疗者作为对照组,40例行夹线牵引辅助内镜黏膜下剥离术者作为观察组。比较两组治疗情况(整块切除率、治愈性切除率)、手术操作时间及安全性(固有肌层受损、迟发性出血、感染)。结果两组整块切除率与治愈性切除率比较,差异未见统计学意义(P>0.05)。观察组病灶1/2环周以下患者的手术操作时间短于对照组(P<0.05);两组病灶1/2环周及以上、不同病灶方位患者的手术操作时间比较,差异未见统计学意义(P>0.05)。观察组并发症发生率(10.00%,4/40)低于对照组(35.00%,14/40),差异有统计学意义(χ^(2)=7.169,P=0.007<0.05)。结论食管早癌及癌前病变临床治疗中采取夹线牵引辅助内镜黏膜下剥离术可取得显著效果,能缩短病灶1/2环周以下患者的手术操作时间,并提高手术安全性。

Objective To analyze the clinical effect of splint traction assisted endoscopic submucosal dissection on esophageal early cancer and precancerous lesions.Methods Eighty patients with early esophageal cancer and precancerous lesions admitted to the Second People's Hospital of Nanyang from October 2018 to October 2021 were selected as the research subjects.All patients underwent endoscopic submucosal dissection surgery.They were divided into a control group and an observation group based on whether to use wire clamping traction assistance,40 patients who did not receive adjuvant therapy with wire clamping traction were enrolled in the control group,40 cases of endoscopic submucosal dissection assisted by wire clamping traction were enrolled in the observation group.The treatment outcomes(overall resection rate,curative resection rate),surgical operation time,and safety(with fixed muscle layer damage,delayed bleeding,infection)were compared between the two groups.Results There was no significant difference in the overall resection rate and curative resection rate between the two groups(P>0.05).The surgical operation time of patients with lesions below 1/2 circumference in the observation group was shorter than that of the control group(P<0.05).There was no significant difference in the surgical operation time between two groups of patients with 1/2 circumference or more of the lesion and patients with different lesion orientations(P>0.05).The incidence of complications in the observation group(10.00%,4/40)was lower than that in the control group(35.00%,14/40),and the difference was significant(χ^(2)=7.169,P=0.007<0.05).Conclusions In the clinical treatment of early esophageal cancer and precancerous lesions,the application of splint-wire traction assisted endoscopic submucosal dissection can achieve remarkable results,shorten the operation time of patients less than 1/2 circle of the lesion,as well as improve the surgical safety.