切换至 "中华医学电子期刊资源库"
高级检索
中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 628 -630. doi: 10.3877/cma.j.issn.1674-3946.2020.06.026

所属专题： 文献；

论著

不同剥离辅助牵引技术辅助ESD治疗食道早癌的临床效果研究
郭建强1,†(), 牛彦杰2, 周斌3, 王晖4   
  1. 1. 710004　西安，西安市第四医院
    2. 712000　陕西咸阳，咸阳市第一人民医院
    3. 710004　西安，西安交通大学第二附属医院
    4. 330008　南昌，南昌大学附属三医院
  • 收稿日期:2020-03-03 出版日期:2020-12-26
  • 通信作者: 郭建强

Study on the clinical effect of different stripping and traction assisted ESD in the treatment of early esophageal cancer

Jianqiang Guo1,†(), Yanjie Niu2, Bin Zhou3, Hui Wang4   

  1. 1. Xi'an Fourth Hospital Xi'an, Shaanxi 710004
    2. Xianyang First People's Hospital Xianyang, Shaanxi 712000
    3. Second Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi 710004
    4. Third Affiliated Hospital of Nanchang University Jiangxi Nanchang 330008
  • Received:2020-03-03 Published:2020-12-26
  • Corresponding author: Jianqiang Guo
  • About author:
    Corresponding author: Guo Jianqiang, Email:
  • Supported by:
    Science and technology research project of social development in shaanxi province(2019SF072); Research project of shaanxi provincial health and family planning commission in 2018(18PJ139)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

郭建强, 牛彦杰, 周斌, 王晖. 不同剥离辅助牵引技术辅助ESD治疗食道早癌的临床效果研究[J]. 中华普外科手术学杂志(电子版), 2020, 14(06): 628-630.

Jianqiang Guo, Yanjie Niu, Bin Zhou, Hui Wang. Study on the clinical effect of different stripping and traction assisted ESD in the treatment of early esophageal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 628-630.

目的

研究不同剥离辅助牵引技术辅助内镜黏膜下剥离术(ESD)治疗食道早癌的临床效果。

方法

选取2017年1月至2018年12月诊治的食管早癌和癌前病变患者共60例，根据术中不同辅助牵引法分为两组，各30例。A组患者行ESD时使用牙线辅助牵引，B组使用橡皮圈辅助牵引。采用统计学软件SPSS 24.0进行数据分析，手术相关指标等计量资料采用(±s)表示，独立样本t检验；术后并发症等计数资料采用χ2检验。P<0.05为差异有统计学意义。

结果

两组手术时间、牵引装置时间、完整剥离时间、一次性完整切除率、平均住院时间差异无统计学意义(P>0.05)．A组止血夹脱落次数为8次(26.7%)，明显高于脱落次数为2次(6.7%)的B组(P<0.05)。A组患者并发症发生率为13.3%，B组为10.0%，差异无统计学意义(P>0.05)。术后随访共12个月，两组患者均未见肿瘤复发和死亡病例。

结论

两种牵引技术均能有效辅助ESD操作，为其提供一个良好的术野，各有特点，临床可根据临床实际需要选择。

关键词: 食管肿瘤, 牵引术, 内镜黏膜下剥离术, 疗效比较研究
Objective

To study the clinical effect of different stripping and traction assisted ESD in the treatment of early esophageal cancer.

Methods

From January 2017 to December 2018, 60 patients with esophageal early cancer and precancerous lesions were selected and divided into two groups, 30 in each group. The patients in group A were treated with floss assisted traction while those in group B were treated with rubber band assisted traction. The measurement data of operation time, traction device time and complete stripping time of the two groups were expressed as (±s), and independent sample t test was used. [n(%)]was used to count the postoperative complications, and χ2 test was used. P<0.05 was considered statistically significant.

Results

There was no significant difference between group A and group B in terms of operation time, traction device time, complete stripping time and average hospitalization time (P>0.05). Group A had 8 times of bleeding clip shedding(26.7%), which was significantly higher than group B with 2 times (6.7%), and the difference was statistically significant (P<0.05). The incidence of complications was 13.3% in group A and 10.0% in group B, with no significant difference between the two groups (P>0.05). The postoperative hospital stay was (10.2±3.4) d in group A and (9.7±3.1) d in group B, with no significant difference between the two groups (P>0.05). The patients were followed up for 12 months. There was no recurrence or death in the two groups.

Conclusion

Both kinds of traction technology can effectively assist ESD operation and provide a good surgical field for it. Each has its own characteristics, which can be selected according to clinical needs.

Key words: Esophageal neoplasms, Traction, Endoscopic submucosal dissection, Comparative effectiveness research
表1 60例食管早癌ESD术中不同辅助牵引法两组一般资料比较[(±s)，例]
组别 例数 性别(男/女) 年龄(岁) 术后病理类别 食管病变部位
a/b/c 上/中/下
A组 30 22/8 61.2±8.1 3/13/14 3/25/2
B组 30 24/6 59.6±7.7 5/12/13 2/24/4
χ2/t - 0.372 0.784 0.577 1.046
P - 0.541 0.218 0.367 0.165
表2 60例食管早癌ESD术中不同辅助牵引法两组患者手术相关情况比较(±s)
组别 例数 手术时间(min) 牵引装置时间(s) 完整剥离时间(min) 止血夹脱落次数[n(%)]
A组 30 69.4±7.1 98.2±19.5 48.2±10.1 8(26.7)
B组 30 66.7±6.8 94.3±17.6 46.3±11.2 2(6.7)
χ2/t - 1.504 0.813 0.690 4.320
P - 0.068 0.209 0.246 0.037
[1]
Bray F, Ferlay J, Soerjomataram I，et al.Global Cancer Statistics 2018：GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]．CA: A Cancer Journal for Clinicians，2018, 68(6): 394-424.
[2]
王蕾，李鹏．早期食管癌及癌前病变的内镜治疗进展[J]．首都医科大学学报，2016, 37(5): 607-610.
[3]
Pinmntel-Nunes P, Dinis-Ribeiro M, Ponchon T，et al.Endoscopic submucosal dissection：European Society of Gastrointestinal Endoscopy (ESGE) Guideline[J]．Endoscopy，2015, 47(9): 829-854.
[4]
王宁，刘硕，杨雷，等.2018全球癌症统计报告解读[J/CD]．肿瘤综合治疗电子杂志，2019, 5(1): 87-97.
[5]
Dutta S, Surapaneni BK, Bansal A．Marked inhibition of cellular proliferation in the normal human esophageal epithelial cells and human esophageal squamous cancer cells in culture by carotenoids：Role for prevention and early treatment of esophageal cancer[J]．Asian Pac J Cancer Prev，2018, 19 (11): 3251-3256.
[6]
中华医学会消化内镜学分会，中国抗癌协会肿瘤内镜专业委员会．中国早期食管癌筛查及内镜诊治专家共识意见(2014年，北京)[J]．中华消化内镜杂志，2015, 32(4): 205-224.
[7]
苏虹，陈进忠，刘明，等．内镜黏膜下剥离术治疗早期食管癌的疗效分析[J]．中华消化内镜杂志，2017, 34(1): 56-58.
[8]
Rahouma M, Harrison S, Kamel M，et al.Consequences of refusing surgery for esophageal cancer: a national cancer database analysis[J]．Ann Thorac Surg，2018, 106 (5): 1476-1483.
[9]
Nagai K, Uedo N, Yamashina T，et al.A comparative study of grasping-type scissors forceps and insulated-tip knife for endoscopic submucosal dissection of early gastric cancer：a randomized controlled trial[J]．Endosc Int Open，2016, 4(6): E654-E660.
[10]
刘姚江，林辉，樊超强，等．内镜黏膜下剥离术治疗食管早癌及癌前病变384例临床分析[J]. 第三军医大学学报，2018, 40(11): 1022-1027.
[11]
王小云，唐学军，谈春晓，等．止血夹牙线牵引辅助技术在内镜黏膜下剥离胃角早期癌中的应用价值研究[J]．中华消化内镜杂志，2015, 32(12): 821-824.
[12]
Oyama T, Tomori A, Hotta K，et al.Endoscopic submucosal dissection of early esophageal cancer[J]．Clin Gastroenterol Hepatol，2005, 3(7 Suppl 1): S67-S70.
[13]
Chua T, Fukami N．Upfront endoscopic submucosal dissection for superficial squamous cell carcinoma is superior to upfront surgical therapy[J]．Gastrointest Endosc，2018, 88(4): 634-636.
[14]
陈相波，许婷婷，吴秋丽，等．橡皮圈牵引与牙线牵引辅助内镜黏膜下剥离术治疗消化道肿瘤的临床对比研究[J]．上海交通大学学报(医学版)，2017, 37(7): 1010-1014.
[1] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[2] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[3] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[4] 汪毅, 许思哲, 任章霞. 胸乳入路腔镜单侧甲状腺叶切除术与开放手术对分化型甲状腺癌患者术后恢复的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 542-545.
[5] 范伟强, 林师佈, 孙传伟, 宋奇锋, 李望, 符誉, 陈艾. 不同切除范围的Bismuth-Corlette Ⅲ、Ⅳ型腹腔镜肝门部胆管癌手术临床对比分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 423-426.
[6] 陈滔, 罗洪, 周进军. 老年食管癌单纯放疗及同期放化疗患者急性不良反应影响因素分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 405-407.
[7] 王新团, 李博, 李栋, 马宁, 李宝平, 刘淑萍. Laennec膜入路与Glisson鞘入路在腹腔镜解剖性肝切除中的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 418-422.
[8] 张杰, 吕远, 孙亮, 苏惠, 谢惠, 袁强, 王昕, 杜峻峰, 金鹏, 陈纲. 腹腔镜-胃镜联合手术处理困难部位胃间质瘤的临床分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 284-286.
[9] 刘烺飚, 牛磊, 蔡军. λ型食管空肠吻合在全腹腔镜下全胃切除术中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 287-291.
[10] 柴吉鑫, 张雪, 何时知, 齐艳涛, 王婧婧, 敖亚洲, 陈泳. 不同穿刺方法对甲状腺结节细胞学检查的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 315-318.
[11] 齐鑫, 赵瑞, 刘思源, 徐斌, 牛艺璇, 刘志鹏, 折占飞. 保留哺乳功能的改良乳头内陷矫正术[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 201-204.
[12] 王帅, 赵丽霞, 王涛, 杨熊飞. 腹腔镜和开腹直肠后补片悬吊固定术治疗男性直肠脱垂的临床疗效对比[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 197-200.
[13] 侯超, 潘美辰, 吴文明, 黄兴广, 李翔, 程凌雪, 朱玉轩, 李文波. 早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 383-387.
[14] 刘晗, 李惠, 朱宇新, 于淼, 李莞盈, 王爽, 狄育竹, 宁丹丹, 曲波. 新型生物材料在内镜黏膜下剥离术中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(03): 167-171.
[15] 倪修凡, 陈磊, 印健, 张利, 高苏俊, 朱振. 内镜下不同术式治疗直肠神经内分泌肿瘤临床研究[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 173-179.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号