Application of rubber ring endoluminal traction assisted by endoscopic mucosal dissection in the treatment of colorectal lateral developmental type lesions
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摘要:目的
分析橡皮圈腔内牵引辅助内镜黏膜下剥离术(ESD)治疗结直肠侧向发育型病变的操作方法、安全性和疗效。
方法选取南通市肿瘤医院内镜中心2016年1月—2022年6月收治的85例行ESD治疗的结直肠侧向发育型病变患者作为研究对象，均采用橡皮圈腔内牵引辅助ESD技术(标记病变、黏膜下注射、环形切开、橡皮圈固定病变和完整剥离病灶)治疗。观察本组患者病变完整切除率、手术操作时间、术中并发症、术后并发症和术后复发情况。
结果85例患者病变完整切除率为100.0%, 手术时间30~110min, 中位时间55min; 5例患者术中发生少量出血(平均出血量20mL), 均经内镜下电凝成功止血; 1例患者出现术后迟发性穿孔，经保守治疗后好转。2例患者术后病理结果提示腺癌，黏膜下层浸润深度大于1000μm, 四周切缘阴性，后追加外科手术治疗。随访3~6个月，所有患者创面预后良好，无局部复发。
结论橡皮圈腔内牵引辅助ESD技术能为术者提供良好的操作视野，可缩短手术操作时间，降低结直肠侧向发育型病变患者术中及术后并发症发生率。
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关键词:
- 结直肠侧向发育型病变 /
- 内镜黏膜下剥离术 /
- 橡皮圈 /
- 腺癌 /
- 迟发性穿孔
Abstract:ObjectiveTo analyze the operating methods, safety and efficacy of rubber band endoluminal traction assisted by endoscopic mucosal dissection (ESD) in the treatment of colorectal lateral developmental type lesions.
MethodsEighty-five patients with colorectal lateral developmental lesions undergoing ESD treatment admitted to Endoscopy Center of Nantong Cancer Hospital from January 2016 to June 2022 were selected as study objects, and all patients were treated with the elastic band endoluminal traction assisted by ESD technology (marking the lesion, submucosal injection, annular incision, fixation of the lesion by elastic band, complete dissection of the lesion). The complete resection rate, operation time of operation, intraoperative complications, postoperative complications and postoperative recurrence were observed.
ResultsThe complete resection rate of 85 patients was 100.0%, the operative time was 30 to 110 min, with the median time of 55 min. There was 5 cases had a small amount of bleeding (with mean volume of 20 mL) during the operation, which was stopped by electric coagulation. Postoperative delayed perforation occurred in 1 patient and was improved after conservative treatment. Postoperative pathology of two patient suggested adenocarcinoma with submucosal infiltration greater than 1 000 μm. The peripheral margin was negative, and then additional treatment was given. One patient had postoperative perforation, and was improved after conservative treatment. During follow-up for 3 to 6 months, all patients had good wound healing without local recurrence.
ConclusionRubber band endoluminal traction assisted by ESD can provide the operator with a good view of the operation, shorten the operation time and reduce incidence rates of complications in intraoperation and postoperation.
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[1] 刘冠伊, 戎龙, 郭新月, 等. 橡皮圈组织夹内牵引辅助在内镜黏膜下剥离术治疗结直肠病变中的应用(含视频)[J]. 中华消化内镜杂志, 2021, 38(7): 545-550. doi: 10.3760/cma.j.cn321463-20201116-00324 [2] 罗家乐, 凌鑫, 杨柳, 等. 内镜黏膜下剥离术联合圈套器法对巨大结直肠病变的疗效探讨[J]. 临床消化病杂志, 2018, 30(5): 289-292. doi: 10.3870/lcxh.j.issn.1005-541X.2018.05.06 [3] 蔡世伦, 钟芸诗, 时强, 等. 体外牵引辅助在内镜治疗上消化道黏膜下肿瘤中的应用[J]. 中华消化内镜杂志, 2015, 32(12): 841-843. doi: 10.3760/cma.j.issn.1007-5232.2015.12.015 [4] YAMAMOTO K, SHIMODA R, OGATA S, et al. Perforation and postoperative bleeding associated with endoscopic submucosal dissection in colorectal tumors: an analysis of 398 lesions treated in Saga, Japan[J]. Intern Med Tokyo Jpn, 2018, 57(15): 2115-2122. doi: 10.2169/internalmedicine.9186-17
[5] 邝继孙, 陈文妹, 孔灿灿, 等. 经口牙线牵引辅助内镜下黏膜剥离术治疗早期胃癌的效果及学习曲线分析[J]. 局解手术学杂志, 2020, 29(4): 288-292. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202004007.htm [6] 叶春荣, 付肖岩, 伍登煇. ST帽+口袋法在高位胃和结肠早期黏膜病变ESD中的应用[J]. 牡丹江医学院学报, 2020, 41(3): 89-91. https://www.cnki.com.cn/Article/CJFDTOTAL-MDJB202003020.htm [7] DE CEGLIE A, HASSAN C, MANGIAVILLANO B, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review[J]. Crit Rev Oncol Hematol, 2016, 104: 138-155. doi: 10.1016/j.critrevonc.2016.06.008
[8] KIM T J, KIM E R, HONG S N, et al. Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists[J]. Intest Res, 2017, 15(2): 228-235. doi: 10.5217/ir.2017.15.2.228
[9] 牛应林, 黄鑫源, 冀明, 等. 橡皮圈腔内牵拉法在内镜黏膜下剥离术中辅助价值研究[J]. 中华消化内镜杂志, 2022, 39(2): 114-117. doi: 10.3760/cma.j.cn321463-20210506-00918 [10] 郭建强, 牛彦杰, 周斌, 等. 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(6): 628-630. doi: 10.3877/cma.j.issn.1674-3946.2020.06.026. [11] 刘晓, 王燕斌, 于剑锋, 等. 新型牵引装置在结直肠侧向发育型肿瘤内镜黏膜下剥离术中的有效性研究[J]. 中华消化内镜杂志, 2020, 37(12): 874-879. doi: 10.3760/cma.j.cn321463-20200714-00626 [12] 陈伟琴, 胡明富, 季峰. 不同病变部位和年龄段患者内镜黏膜下剥离术后并发症发生率的比较[J]. 中华消化杂志, 2019, 39(7): 473-477. doi: 10.3760/cma.j.issn.0254-1432.2019.07.007 [13] SUZUKI S, GOTODA T, KOBAYASHI Y, et al. Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos)[J]. Gastrointest Endosc, 2016, 83(2): 337-346. doi: 10.1016/j.gie.2015.07.014
[14] 吴振文, 王立生. 钛夹辅助圈套器牵引技术在内镜治疗中的研究进展[J]. 微创医学, 2021, 16(2): 249-254. https://www.cnki.com.cn/Article/CJFDTOTAL-WCYX202102031.htm [15] SAITO Y, EMURA F, MATSUDA T, et al. A new sinker-assisted endoscopic submucosal dissection for colorectal cancer[J]. Gastrointest Endosc, 2005, 62(2): 297-301. doi: 10.1016/S0016-5107(05)00546-8
[16] 丁鹏. 牵引辅助内镜粘膜下剥离术治疗≥ 15 mm结直肠病变的疗效及安全性的Meta分析[D]. 太原: 山西医科大学, 2021. [17] 陈相波, 宋玉琼, 许婷婷, 等. 橡皮圈腔内牵引辅助内镜黏膜下剥离术在右半结肠侧向发育型肿瘤治疗中的应用[J]. 精准医学杂志, 2022(3): 204-207, 212. https://www.cnki.com.cn/Article/CJFDTOTAL-SPAN202203004.htm -
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