橡皮圈与牙线牵引辅助内镜黏膜下剥离术治疗消化道早癌的疗效比较

Comparative study of therapeutic effect of rubber ring and dental floss combined with hemoclipping assisted endoscopic submucosal dissection on early gastrointestinal tumor

目的比较橡皮圈牵引和牙线牵引辅助内镜黏膜下剥离术(ESD)对消化道早癌患者的疗效。方法103例消化道早癌患者根据ESD中辅助牵引技术的不同,分为橡皮圈牵引组(橡皮圈组,51例)和牙线牵引辅助组(牙线组,52例)。比较2组术前基本情况、黏膜下补充注射量、术中止血夹脱离次数、出血量、手术时间、术后迟发性出血、肿瘤一次性完整切除率、术后住院时间及术后72 h并发症发生率。术后3、6、12个月时进行疼痛视觉模拟量表(VAS)和简明健康状况调查表(SF-36)评分,统计术后12个月内并发症情况。结果橡皮圈组术前黏膜下补充注射体积、术中出血量、止血夹脱离次数、手术时间、术后72 h并发症发生率和术后住院时间均低于牙线组(P<0.05);2组术后迟发性出血发生率比较差异无统计学意义(P>0.05)。随访12个月,橡皮圈组患者手术后疼痛程度较轻、生活质量良好,手术后12个月内并发症发生率降低(P<0.05)。结论与牙线牵引辅助比较,橡皮圈牵引辅助ESD可缩短手术时间,减少术后并发症,值得推广。

Objective To compare the effect of rubber ring versus dental floss combined with hemoclipping assisted en⁃doscopic submucosal dissection(ESD)in the treatment of early gastrointestinal tumor.Methods A total of 103 patients with early gastrointestinal cancer were divided into the rubber band traction group(rubber band group,n=51)and the dental floss traction assist group(dental floss group,n=52)according to different assisted traction techniques during ESD.The basic con⁃ditions of the two groups were compared before operation,as well as the amount of submucosal injection,installation time of the traction device,the amount of bleeding during operation,the time of operation,the delayed bleeding after operation,one-time complete resection rate of tumor,days in hospital after operation and complication rate at 72 hours after operation.The degree of postoperative pain(VAS pain Score),follow-up quality of life(SF-36 Score)and complications 12 months after op⁃eration were also recorded.Results The intraoperative submucosal injection volume,intraoperative bleeding volume,num⁃ber of hemostatic clamp detachment,surgical time,complication rate 72 hour after operation and postoperative hospital stay were lower in the rubber band group than those in the dental floss group(P<0.05).There was no significant difference in the number of delayed postoperative bleeding between the two groups(P>0.05).After 12 months of follow-up,patients in the rubber band group had mild postoperative pain and good quality of life.The incidence of complications decreased within 12 months after surgery in the rubber band group(P<0.05).Conclusion Compared with floss traction aid,rubber ring traction aid ESD can shorten the operation time and reduce postoperative complications,which is worth popularizing.