Q法自牵引技术在大范围早期食管癌内镜 黏膜下剥离术中的应用研究（含视频）

目的初步报告Q法自牵引辅助内镜黏膜下剥离术(Q-ESD)应用于大范围早期食管癌(EEC)的临床效果。方法回顾性分析2015年1月至2018年12月间在福建省立医院接受ESD治疗的82例大范围EEC(单发病灶>1/2周径或纵径长度>5 cm)患者病例资料,按治疗方案不同分为传统ESD组(n=44)和Q-ESD组(n=38),比较两组操作面积、操作时间、操作速度、整块切除率、完整切除率、并发症情况。结果82例病灶均于内镜下成功整块切除。Q-ESD组和传统ESD组在操作面积779.8(329.9~2552.5)mm^2比875.7(417.8~1914.8)mm^2,U=155,P=0.636]、操作时间63(41~177)min比59(42~169)min,U=171,P=0.167]、完整切除率94.7%(36/38)比93.2%(41/44),χ^2=0.086,P=0.769]方面比较差异无统计学意义。但Q-ESD组操作速度快14.9(5.4~20.8)mm^2/min比9.0(5.0~19.5)mm^2/min,U=142,P=0.035],固有肌层损伤发生率低7.9%(3/38)比27.3%(12/44),χ^2=5.123,P=0.023],术后狭窄发生率低5.3%(2/38)比20.5%(9/44),χ^2=4.051,P=0.044]。除传统ESD组有1例穿孔外,未发生其他不良事件。结论Q-ESD是治疗大范围EEC安全有效的可选策略。

Application of Q self-traction method in endoscopic submucosal dissection to the treatment of large early esophageal cancer

Objective To preliminarily study the effect of Q self-traction endoscopic submucosal dissection(Q-ESD)on treatment of large early esophageal cancer(EEC).Methods A retrospective analysis was performed on the data of 82 cases of large EEC(single lesion>1/2 cross-section diameter or longitudinal diameter length>5 cm)who underwent ESD on Fujian Provincial Hospital between January 2015 and December 2018.According to the treatment schedule,patients were divided into the conventional ESD group(n=44)and the Q-ESD group(n=38).The procedural area,time,and speed,en bloc resection rate,complete resection rate and complications of the two groups were analyzed.Results All of the 82 lesions were resected completely under endoscope.There was no statistical difference in the procedural area779.8(329.9-2552.5)mm^2 VS 875.7(417.8-1914.8)mm^2,U=155,P=0.636],procedural time63(41-177)min VS 59(42-169)min,U=171,P=0.167]and complete resection rate94.7%(36/38)VS 93.2%(41/44),χ^2=0.086,P=0.769]between the Q-ESD group and the conventional ESD group.Compared with the conventional ESD group,the Q-ESD group had a faster dissection speed14.9(5.4-20.8)mm^2/min VS 9.0(5.0-19.5)mm^2/min,U=142,P=0.035],lower muscularis propria injury rate7.9%(3/38)VS 27.3%(12/44),χ^2=5.123,P=0.023],and a lower stricture rate5.3%(2/38)VS 20.5%(9/44),χ^2=4.051,P=0.044].No other adverse events occurred except for one case of perforation in the conventional ESD group.Conclusion The new traction technique of Q-ESD is a safe and effective treatment for large EEC.