一种简易牵引装置在结肠内镜黏膜下剥离术中的临床应用（含视频）

Clinical application of a simple traction device to colonic endoscopic submucosal dissection (with video)

摘要:

评估在结肠内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）中，金属夹联合丝线和橡皮圈作为简易内牵引装置的临床应用价值。以2021年1月至2022年7月间，在南通大学附属江阴医院进行ESD治疗的56例早期结肠癌和癌前病变患者为研究对象，采用计算机软件随机分配，分为常规ESD治疗的对照组（n=28）和金属夹联合丝线及橡皮圈牵引的牵引组（n=28）。对两组患者的ESD手术总时间、黏膜剥离时间、黏膜下注射次数、完整切除病灶率、手术并发症等情况进行综合比较。结果牵引组手术总时间较对照组短［（74.64±33.25）min比（117.18±35.75）min，t=4.61，P<0.001］；牵引组黏膜剥离时间较对照组短［（51.61±24.87）min比（99.11±32.73）min，t=6.11，P<0.001］；牵引组黏膜下注射次数较对照组少［（1.68±1.16）次比（4.96±1.41）次，t=9.57，P<0.001］；两组患者在手术面积和完整切除率及手术并发症方面差异无统计学意义（P>0.05）。可见，金属夹联合丝线及橡皮圈的作为牵引辅助装置，可以降低结肠ESD的技术难度，缩短手术时间。

Abstract:

To evaluate the application value of metal clip combined with suture and rubber coil as a simple traction device in endoscopic submucosal dissection (ESD) for intestinal mucosal lesions, a total of 56 patients with early colonic cancer and precancerous lesions who received ESD in Jiangyin People""s Hospital from January 2021 to July 2022 were randomly divided into the control group (n=28, conventional ESD) and the traction group (n= 28, suture and rubber coil as a simple traction device). The total time of ESD, mucosal dissection time, number of submucosal injections, complete resection rate and complications were compared between the two groups. The operation time of the traction group was shorter than that of the control group (74.64±33.25 min VS 117.18±35.75 min, t=4.61,P<0.001). The desection time of mucosa in the traction group was shorter than that in the control group (51.61±24.87 min VS 99.11±32.73 min, t=6.11, P<0.001). The number of submucosal injection in the traction group was less than that of the control group with significant difference (1.68±1.16 VS 4.96±1.41, t=9.57,P<0.001). There was no significant differences in operation area, complete resection rate or complication between the two groups (P>0.05). The traction assistance technology of metal clip combined with suture and rubber coil can reduce the technical difficulty of colonic ESD and shorten the operation time.