摘要
目的探讨应用注水型电刀行推进式内镜黏膜下剥离术(PESD)切除大面积贲门早癌及癌前病变的价值,并分析总结相关技术要点。方法选取2017年1月-2020年12月在保定市第一中心医院内镜诊疗中心通过胃镜活检及放大染色内镜检查考虑贲门早癌或高级别上皮内瘤变且病变最大径>2.0 cm的病例,术中用注水型电刀行PESD治疗,并选取该中心同期该医生以普通黏膜切开刀行贲门常规内镜黏膜下剥离术(ESD)治疗的病例,对比分析两组病例的单位面积剥离速度、病变完整切除率、并发症发生率(术后迟发性出血和穿孔)等。结果PESD组(n=32)病变直径2.0~8.0 cm,平均(5.1±2.9)cm;其中1处病变位于前壁,16处位于后壁,3处位于大弯侧,12处位于小弯侧;30处病变为一次性切除,2处病变(贲门大弯侧)为分块切除;剥离时间19~112 min,平均(65.5±48.3)min;术中出血8例(25.0%),无迟发性出血及穿孔发生,术后住院3~5 d;ESD组(n=17)病变直径2.0~6.5 cm,平均(4.2±2.2)cm;2处病变位于前壁,10处位于后壁,5处位于小弯侧;所有病变均为一次性切除;剥离时间26~157 min,平均(91.5±26.5)min;术中出血8例(47.1%),术中穿孔2例(11.8%),均给予金属夹夹闭并内科保守治疗取得成功,无迟发性出血和迟发性穿孔发生,术后住院3~6 d。结论应用注水型电刀行PESD是一种基于贲门解剖结构的创新术式,与常规ESD相比,可有效提高剥离速度,降低并发症发生率,使内镜手术更安全和快捷。
Objective To explore the application value of water-injected mucosal incision(Golden Knife)pushing endoscopic submucosal dissection for large area of early cardiac cancer and precancerous lesions.Methods Patients with early cardiac carcinoma or high-grade intraepithelial neoplasia with the maximum diameter of>2.0 cm were selected through endoscopic biopsy and magnification staining endoscopy from January 2017 to December 2020,pushing endoscopic submucosal dissection(PESD)was performed with Golden Knife,and patients treated with conventional endoscopic submucosal dissection(ESD)of cardia by the same doctor under ordinary mucosal resection were selected,the peel-away speed of unit area,the rate of complete resection of lesions,and the incidence of complications(postoperative delayed bleeding and perforation)were compared and analyzed between the two groups.Results The diameter of the lesions in the PESD group(n=32)was 2.0~8.0 cm,average(5.1±2.9)cm;Of which 1 case was located in the anterior wall,16 cases were located in the posterior wall,3 cases were located in the greater curvature,and 12 cases were located in the lesser curvature;30 cases had a one-time resection,2 cases(the greater curvature of the cardia)was segmented;The stripping time was 19~112 min,average(65.5±48.3)min.8 cases had intraoperative bleeding(25.0%),without delay bleeding and perforation,postoperative hospital stay was 3~5 d.ESD group(n=17)with a diameter of 2.0~6.5 cm,mean(4.2±2.2)cm;2 cases were located in the anterior wall,10 cases were located in the posterior wall,and 5 cases were located in the lesser curvature;All lesions were removed at one time,and the stripping time was 26~157 min,average(91.5±26.5)min;Eight patients had intraoperative bleeding(47.1%),2 patients had perforation during surgery(11.8%),all patients were treated with metal clamps and conservative medical treatment was successful.There was no delayed bleeding and delayed perforation,and the postoperative hospital stay was 3~6 d.Conclusion The application of the Golden
作者
熊英
韩静
朱亚男
于晓欢
陈玉杰
侯丛然
于占江
高雪梅
张金卓
Ying Xiong;Jing Han;Ya-nan Zhu;Xiao-huan Yu;Yu-jie Chen;Cong-ran Hou;Zhan-jiang Yu;Xue-mei Gao;Jin-zhuo Zhang(Department of Digestive Diseases(Key Laboratory of Molecular Pathology and Early Diagnosis of Tumor in Hebei Province),Baoding No.1 Central Hospital,Baoding,Hebei 071000,China;Department of Endoscopic Diagnosis and Treatment Center,Baoding No.1 Central Hospital,Baoding,Hebei 071000,China)
出处
《中国内镜杂志》
2021年第11期42-48,共7页
China Journal of Endoscopy
关键词
内镜黏膜下剥离术
贲门早癌
贲门癌前病变
推进式内镜黏膜下剥离术
注水黏膜切开刀
endoscopic submucosal dissection
early cardiac carcinoma
precancerous lesion of cardiac
pushing endoscopic submucosal dissection
water-injected mucosal incision
