自控式链圈联合组织夹牵引辅助技术在困难部位早期结直肠肿瘤ESD中的应用

Self-controlled chain ring combined with tissue clip traction-assisted technique in ESD of early colorectal tumors in difficult sites

摘要:

目的:探讨自控式链圈联合组织夹牵引辅助技术在困难部位早期结直肠肿瘤ESD中的应用价值,评估该技术在内镜下黏膜剥离术(Endoscopic submucosal dissection,ESD)中的疗效性及安全性。 方法：选择2021年01月—2024年04月在江苏省中医院消化内镜中心行ESD治疗的早期结直肠肿瘤（困难部位）患者61例，根据治疗方法分为两组，其中牵引辅助ESD组（试验组）29例，传统ESD组（对照组）32例，比较两组患者的年龄、性别、肿瘤大小、形态、位置、Pit Pattern分型、病理类型、浸润深度、一次性完整切除、治愈性切除率，以及困难部位剥离时间、并发症（术中出血、肌层损伤、穿孔、术后迟发性穿孔、出血）等情况。 结果：两组患者在年龄、性别、肿瘤大小、形态、位置、Pit Pattern分型、病理类型、浸润深度、一次性完整切除、治愈性切除方面均无统计学差异（P＞0.05）；在困难部位剥离时间方面有显著统计学差异（P＜0.001），试验组效率明显优于对照组；并发症方面，试验组术中1例出现固有肌层浅层损伤，未发生穿孔及不可控制的出血，对照组术中6例出现固有肌层损伤，2例出现微穿孔，未发生不可控制出血，试验组并发症的发生率低于对照组（P＜0.05）。 结论：自控式链圈联合组织夹牵引辅助技术在困难部位早期结直肠肿瘤ESD中有显著临床疗效，自控调节，操作便捷，安全可靠，效价比高，在“超级微创”及“后ESD”内镜时代大大提高剥离效率，值得临床推广应用。

Abstract:

Objective：To investigate the value of self-controlled chain ring combined with tissue clip traction-assisted technique in ESD of early colorectal tumors in difficult sites and to evaluate the efficacy and safety of this technique in endoscopic submucosal dissection (ESD). Methods: Sixty-one patients with early colorectal tumors (difficult sites) who underwent ESD treatment at the Gastrointestinal Endoscopy Center of Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2021 to April 2024 were selected and divided into two groups according to the method of treatment, with 29 cases in the traction-assisted ESD group (experimental group) and 32 cases in the traditional ESD group (control group), and the two groups were compared with each other in terms of age, gender, tumor size, morphology, location, Pit Pattern typing, pathologic type, depth of infiltration, one-time complete resection, curative resection rate, as well as the time of difficult site dissection, and complications (intraoperative hemorrhage, muscular layer injury, perforation, delayed postoperative perforation, and hemorrhage), etc. Results：There was no statistically significant difference between the two groups in terms of age, gender, tumor size, morphology, location, Pit Pattern typing, pathological type, depth of infiltration, one-time complete resection, and curative resection (P＞0.05); there was a statistically significant difference in terms of the time to peel off the difficult site (P＜0.001), and the efficiency of the experimental group was significantly better than that of the control group. Conclusions: Self-controlled chain ring combined with tissue clip traction-assisted technology in difficult areas of early colorectal tumor ESD has significant clinical efficacy, self-regulation, convenience, safety, reliability, and high cost-effectiveness in the“super minimally invasive”and“post-ESD”endoscopic eras. It is worth being popularized and applied in clinical practice.