摘要目的 评价新型带线缝合夹悬吊法用于胃部ESD术的安全性和有效性.方法 根据SPSS软件将20个离体猪胃模型随机分为实验组(n=10)和对照组(n=10),每个模型均于胃窦大弯和胃窦后壁各进行1次相同方法的ESD,操作由同一名内镜医生和同一名护士完成.对比分析穿孔发生率、剥离黏膜直径、总的剥离时间、黏膜暴露至完整剥离时间、黏膜下注射次数及一次性完整切除率的组间差异.结果 40例次离体猪胃胃窦部ESD操作均成功完成,拟切除黏膜均一次性完整剥离,无一例次出现穿孔.(1)胃窦大弯ESD:2组在剥离黏膜直径方面差异无统计学意义(P=0.368),总的剥离时间实验组和对照组分别为(34.70± 1.06) min和(37.10±2.23) min(P=0.009)、黏膜下暴露至完整剥离时间实验组和对照组分别为(31.40±2.00) rin和(34.80±2.20) min(P=0.817),黏膜下注射次数实验组和对照组分别为(7.60±1.00)次和(10.60±1.00)次(P＜0.001).(2)胃窦后壁ESD:2组在剥离黏膜直径方面差异无统计学意义(P=0.368),实验组总的剥离时间较对照组明显缩短[(37.00±1.25) min比(39.60±1.65) min,P＜0.001],黏膜下暴露至完整剥离时间较对照组明显缩短[(34.50±1.35) min比(37.00± 1.25) min,P＜0.001],黏膜下注射次数较对照组明显减少[(7.60±1.27)次比(11.40±1.00)次,P＜0.001].结论 动物实验初步显示胃部ESD术中使用新型缝合夹悬吊法安全、有效,较之传统ESD方法具有操作时间短、黏膜下注射次数少、简单易行的优势.

abstractsObjective To evaluate the safety and effectiveness of a new hemostatic clip with sutures for ESD suspension method in animal models.Methods A total of 20 porcine stomachs were randomly divided into the experimental group (n=10) and the control group (n=10).ESD was done respectively in antrum greater curvature and antrum back wall of porcine stomach in vitro.All procedures were completed by the same endoscopist and nurse.The incidence of perforation,mucosa diameter,total operation time (T),dissection time (T1),the average number of submucosal injection,and one-time complete dissection rate were compared between two groups.Results Procedures were done successfully in antrum of 40 poccine in vitro and all mucosa were dissected completely in one procedure.No perforation occurred.Compared with the control group,the mucosa diameter difference was not statistically significant (P =0.368).The total operating time [(34.70± 1.06) min VS (37.1 0± 2.23) min,P =0.009],dissection time [(31.40± 2.00) min VS (34.80± 2.20) min,P=0.817] and the average number of submucosal injection[(7.60± 1.00) VS (10.60± 1.00),P＜0.001] in antral greater curvature ESD of the experimental group were significantly less than those of the control group.As for the antrum back wall,the mucosa diameter difference was not statistically significant.The total operation time [(37.00± 1.25) min VS (39.60± 1.65) min,P＜0.001],dissection time[(34.50± 1.35) min VS (37.00± 1.25) min,P＜0.001],the average number of submucosal injection [(7.60± 1.27) VS (11.40± 1.00),P＜0.001] were also significantly less than those of the control.Conclusion The new hemostatic clip with sutures for suspension can significantly shorten the operation time,reduce the number of submucosal injections and the difficulty in ESD.