橡皮圈预牵引辅助内镜黏膜下挖除术在胃黏膜下肿瘤中的应用研究(含视频)

Application of rubber band‑assisted endoscopic submucosal excavation to gastric submucosal tumors(with video)

目的评价橡皮圈预牵引辅助内镜黏膜下挖除术(rubber band-assisted endoscopic submucosal excavation,RB-ESE)治疗胃黏膜下肿瘤(submucosal tumors,SMT)的安全性和有效性。方法采用回顾性研究方法,将2017年1月至2022年8月期间,因胃SMT在扬州大学附属医院行内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)治疗的48例患者根据手术方式不同,分为两组,分别为RB-ESE组20例、传统ESE(conventional ESE,C-ESE)组28例。统计两组患者的手术时间、术中出血及穿孔发生率、黏膜帽保留情况、金属夹应用数量、术后相关并发症、住院时间等指标。分析手术相关并发症与病变长径、部位的相关性,及出血与穿孔的相关性。结果RB-ESE组和C-ESE组患者一般资料差异无统计学意义(P>0.05)。RB-ESE组和C-ESE组手术时间分别为(14.82±2.31)min和(23.70±3.67)min,RB-ESE组手术时间显著缩短(t=-9.539,P<0.001)。RB-ESE组和C-ESE组术中出血率分别为20.0%(4/20)和42.9%(12/28),差异无统计学意义(χ^(2)=2.743,P=0.098);术中穿孔率分别为25.0%(5/20)和46.4%(13/28),差异无统计学意义(χ^(2)=2.286,P=0.131);黏膜帽保留率分别为60.0%(12/20)和7.1%(2/28),差异有统计学意义(χ^(2)=15.777,P<0.001);金属夹使用数量分别为(8.05±1.40)个和(10.43±1.96)个,差异有统计学意义(t=4.925,P<0.001);术后住院时间分别为(4.35±0.75)d和(5.00±0.86)d,差异有统计学意义(t=2.724,P=0.009)。两组均无术后出血和穿孔发生。综合两组资料发现SMT术中穿孔、出血的发生与瘤体长径有关,瘤体长径≥2 cm患者术中出血、穿孔率显著增加,分别为68.4%(13/19)(P<0.001)和78.9%(15/19)(P<0.001),且出血与穿孔之间有相关性(P<0.001)。结论RB-ESE较传统ESE手术时间显著缩短,术后可大部分保留病变处黏膜帽,减少金属夹使用,并缩短住院时间,可推广橡皮圈牵引辅助在ESE中的应用。

Objective To evaluate the safety and effectiveness of rubber band-assisted endoscopic submucosal excavation(RB-ESE)for gastric submucosal tumors(SMT).Methods A retrospective study was conducted on data of gastric SMT patients who underwent ESE in Affiliated Hospital of Yangzhou University from January 2017 to August 2022.A total of 48 patients were selected and divided into two groups:RB-ESE group(n=20)and the conventional ESE(C-ESE)group(n=28).The operation time,bleeding rate and perforation rate during operation,the retention rate of the mucosal cap,the number of clips,postoperative complications,and the hospitalization time were analyzed.Additionally,correlations between complications and tumor size/location and between bleeding and perforation were evaluated.Results No significant difference was found in the general conditions between the two groups(P>0.05).The operation time of RB-ESE group(14.82±2.31 min)was significantly shorter than that of C-ESE group(23.70±3.67 min)(t=-9.539,P<0.001).The intraoperative bleeding rates were 20.0%(4/20)and 42.9%(12/28)in the RB-ESE group and C-ESE group respectively(χ^(2)=2.743,P=0.098),while the intraoperative perforation rates were 25.0%(5/20)and 46.4%(13/28)respectively(χ^(2)=2.286,P=0.131).Furthermore,the mucosal cap preservation rate was notably higher in the RB-ESE group at 60.0%(12/20)compared with 7.1%(2/28)in the C-ESE group(χ^(2)=15.777,P<0.001).The number of clips applied to close the wound was 8.05±1.40 and 10.43±1.96 in the RB-ESE group and C-ESE group respectively(t=4.925,P<0.001).The postoperative hospital stays were 4.35±0.75 days and 5.00±0.86 days respectively in two groups(t=2.724,P=0.009).No postoperative bleeding or perforation occurred in either group.The results showed that the occurrence of perforation and bleeding were associated with tumor diameter.Patients with tumor size≥2 cm showed increased proportions of intraoperative bleeding[68.4%(13/19),P<0.001]and perforation[78.9%(15/19),P<0.001].There was a correlation between intraoperative bleeding and perforation(P<0.001).Conclusion RB-ESE proves to be an effective and safe approach for managing gastric SMT,offering advantages such as reduced operation time and hospital stays,improved retention of the mucosal cap post-operation,and less clips use.The results suggest that RB-ESE could be widely adopted for treating SMT.