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

目的 研究新型牵引装置在结直肠侧向发育型肿瘤（laterally spreading tumor，LST）内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）中的有效性。 方法 收集2018年8月—2020年4月首都医科大学附属北京朝阳医院内镜中心经ESD治疗的结直肠LST患者资料，根据手术过程中是否使用牵引，分为传统ESD组（不使用牵引）及牵引辅助ESD组（利用3个夹子和1个橡皮圈组成弹性三角形牵引装置进行牵引）。分析两组总切除时间、黏膜下剥离时间、黏膜下剥离速率以及安全性等相关指标。 结果 共纳入54例结直肠LST患者，其中29例为传统ESD组，25例为牵引辅助ESD组。两组年龄、性别构成、病变位置比较差异均无统计学意义（P>0.05）。牵引辅助ESD组的病变面积为13.30（7.55，15.91）cm2，较传统ESD组的6.90（5.50，13.50）cm2大，差异有统计学意义（U=503.50，P=0.014）。传统ESD组与牵引辅助ESD组总切除时间48.00（35.50，58.00）min比34.00（29.00，35.00）min，U=109.00，P<0.001]和黏膜下剥离时间（39.52±12.37） min比（25.68±7.37）min，t=4.89，P<0.001]比较差异有统计学意义。牵引辅助ESD组黏膜下剥离速率快于传统ESD组0.17（0.13，0.30）cm2/min比0.52（0.30，0.62）cm2/min，U=604.00，P<0.001]。传统ESD组有2例（6.9%）穿孔，牵引辅助ESD无穿孔发生，但穿孔发生率比较差异无统计学意义（P=0.493）。 结论 利用夹子及橡皮圈进行牵引辅助的ESD相对于传统ESD治疗结直肠LST更加安全、有效。

Effectiveness of a novel traction device in endoscopic submucosal dissection for colorectal laterally spreading tumor

Objective To evaluate the effectiveness of a novel traction device in endoscopic submucosal dissection (ESD) for colorectal laterally spreading tumor (LST). Methods Patients with LST treated by ESD in Endoscopic Center of Beijing Chao-yang Hospital of Capital Medical University from August 2018 to April 2020 were enrolled and divided into traditional ESD group (without traction) and traction- assisted ESD group (using an elastic triangle traction device which comprised of 3 clips and 1 rubber band). The total procedure time, submucosal dissection time, submucosal dissection speed and security of the two groups were compared. Results Fifty-four patients with colorectal LST were included, including 29 patients in the conventional ESD group and 25 patients in the traction-assisted ESD group. There were no statistical differences in age, gender composition or lesion location between the two groups (P>0.05). The lesion area of traction-assisted ESD group was larger than that of the traditional ESD group 13.30 (7.55, 15.91) cm2 VS 6.90 (5.50, 13.50) cm2, U=503.50, P=0.014]. The total procedure time 48.00 (35.50, 58.00) min VS 34.00 (29.00, 35.00) min, U=109.00, P<0.001] and submucosal dissection time (39.52±12.37 min VS 25.68±7.37 min, t=4.89, P<0.001) were significantly different between the two groups. In terms of submucosal dissection speed, the assisted-traction ESD group was significantly faster than that of the traditional ESD group 0.17 (0.13, 0.30) cm2/min VS 0.52 (0.30, 0.62) cm2/min, U=604.00, P<0.001]. There were 2 (6.9%) cases of perforation in the traditional ESD group, and no perforation occurred in traction-assisted ESD, but the result was not statistically significant (P=0.493). Conclusion Compared with traditional ESD, traction-assisted ESD with clip and rubber band is safer and more effective in the treatment of colorectal LST.