水充盈法在食管内镜黏膜下剥离术中的临床应用（含视频）

Clinical application of water‑filling method to esophageal endoscopic submucosal dissection (with video)

摘要:

为评价水充盈法内镜黏膜下剥离术（water‑filling endoscopic submucosal dissection，w‑ESD）治疗食管癌或食管癌前病变的适用性、优缺点及安全性，试验组前瞻性纳入2024年9月至2025年2月在中国医科大学附属第四医院消化内镜科经胃镜及活检病理诊断确诊为食管癌或食管癌前病变，并需接受内镜黏膜下剥离术（endoscopic submucosal dissection， ESD）的患者，行w‑ESD；对照组回顾性调取2024年3月至2024年9月本中心经相同诊断流程明确符合上述指征的患者，行常规ESD（conventional ESD，c‑ESD）。记录行w‑ESD的试验组操作者对手术视野、水排出及水存储、术中电刀及电凝使用、术中出血处理、方法难易程度的评分，统计手术操作时间、住院时间、术中及术后并发症等信息。同时收集对照组手术操作时间、住院时间、术中及术后并发症等信息。共入组患者42例，其中试验组20例，对照组22例。入选病例均成功完成手术。试验组术后发热3例，术后肺炎1例。对照组术后发热4例，术后肺炎1例。无术中出血，无术后穿孔、迟发性出血、皮下气肿。试验组手术操作时间为（45.25±13.52）min（15~70 min），住院时间为（7.05±0.61）d（6~9 d）。对照组手术操作时间为（38.64±10.26）min（20~65 min），住院时间为（6.82±0.66）d（6~9 d）。两组手术操作时间（t=1.80，P=0.080）与住院时间（t=1.18，P=0.246）比较差异无统计学意义。操作者对试验组w‑ESD的手术视野、水排出及水存储、术中出血处理、方法难易程度评分均为2分，术中电切效果（1.85±0.37）分、电凝效果（1.90±0.31）分。综上，w‑ESD适用于切开、剥离、创面处理程序，术中视野好，止血快速，值得临床进一步研究及推广。

Abstract:

To evaluate the applicability, advantages, disadvantages and safety of water-filling endoscopic submucosal dissection (w-ESD) for esophageal cancer or precancerous lesions, the experimental group prospectively enrolled patients diagnosed as having esophageal cancer or precancerous lesions confirmed by gastroscopy and biopsy pathological examination who required endoscopic submucosal dissection (ESD) and underwent w-ESD at the Department of Gastroenterology, the Fourth Affiliated Hospital of China Medical University from September 2024 to February 2025. The control group retrospectively retrieved patients meeting the same indications with the same diagnostic process who underwent conventional ESD (c-ESD) from March to September 2024. For the experimental group, the scores of surgical field, water drainage and storage, intraoperative electrotomy and electrocoagulation use, intraoperative hemorrhage management, and the difficulty level of the method given by the operator were recorded, as well as the procedure time, hospital stay, intraoperative and postoperative complications. For the control group, the procedure time, hospital stay, intraoperative and postoperative complications were collected. A total of 42 patients were enrolled, including 20 in the experimental group and 22 in the control group. All patients underwent the operation successfully. In the experimental group, 3 cases of postoperative fever and 1 case of postoperative pneumonia occurred, while 4 cases of postoperative fever and 1 case of postoperative pneumonia occurred in the control group. No postoperative perforation, intraoperative or delayed hemorrhage, or subcutaneous emphysema was observed in either group. The procedure time of the experimental group was 45.25±13.52 minutes (15-70 minutes), and the hospital stay was 7.05±0.61 days (6-9 days). The procedure time of the control group was 38.64±10.26 minutes (20-65 minutes), and the hospital stay was 6.82±0.66 days (6-9 days). There were no significant differences in the procedure time (t=1.80, P=0.080) or the hospital stay (t=1.18, P=0.246) between the two groups. For the experimental group, the scores of surgical field, water drainage and storage, intraoperative hemorrhage management, and the difficulty level of the method were all 2 points, the score of intraoperative electrotomy effect was 1.85±0.37 points, and the score of intraoperative electrocoagulation effect was 1.90±0.31 points. W-ESD is suitable for incision, dissection and wound management procedures, with good intraoperative visual field and rapid intraoperative hemostasis, which is worth of further clinical research and promotion.