摘要目的 探讨内镜黏膜下剥离术(ESD)术中黏膜下注射液加用肾上腺素的必要性.方法 2013年12月至2014年1月间,接受ESD切除治疗且直径≥2 cm的消化道早期癌及癌前病变患者按照随机对照原则分为试验组(n=54)和对照组(n=47),试验组使用生理盐水+靛胭脂混合溶液进行黏膜下注射,对照组使用生理盐水+靛胭脂+肾上腺素混合溶液进行黏膜下注射,对比分析2组手术完成情况及并发症发生情况.结果 2组病变均于ESD术中一次性完整剥离切除,术后病理结果提示切除标本的侧切缘和基底切缘均无肿瘤累及,平均手术时间试验组和对照组分别为(39.4±22.0)min和(41.5±18.7)min,2组在一次性整块切除率、完整切除率、平均手术时间方面差异均无统计学意义(P＞0.05).2组均无术中穿孔和术后迟发性穿孔.试验组术中发生少量出血39例、中量出血15例,对照组术中发生少量出血34例、中量出血12例、大量出血1例,2组术中出血情况比较差异无统计学意义(P＞0.05).试验组有1例直肠病变患者术后第3天出现迟发性出血,对照组无术后迟发性出血,2组术后迟发性出血发生率比较差异无统计学意义(P＞0.05).结论 在运用ESD治疗消化道早期癌及癌前病变时,黏膜下注射液中不加用肾上腺素也能达到与加用肾上腺素相同的效果,并且不会明显增加各类并发症的发生率.

abstractsObjective To investigate the necessity of adding epinephrine to submucosal injection during endoscopic submucosal dissection(ESD).Methods Patients with early cancer and precancerous lesions of digestive system were prospectively enrolled and underwent ESD when the lesion was 2 cm or more in diameter from December 2013 to January 2014.Patients were randomly divided into two groups,the experimental group(n =54)used saline and indigo carmine for submucosal injection,while the control group(n =47) used a mixed solution including saline,indigo carmine and epinephrine for submucosal injection.Several procedure-related indices and delayed complications were compared between groups.Results All the tumors in both groups were removed en bloc,and all resected lesions showed both lateral and deep tumor-free margins.The mean operation time was 39.4 ±22.0 min in the experimental group,and 41.5 ± 18.7 in the control group.There were no statistical differences between two groups in the en bloc resection rate,complete resection rate,and mean operation time (all P ＞ 0.05).There were no intraoperative or delayed perforations in either group.In the experimental group,mild intraoperative bleeding occurred in 39 cases and moderate in 15 cases.In the control group,mild intraoperative bleeding occurred in 34 cases,moderate in 12 cases,and severe in 1 case.Delayed bleeding occurred in 1 case 3 days after ESD in the experimental group,while none happened in the control group.There were no statistical differences between two groups in intraoperative bleeding or delayed bleeding(P ＞ 0.05).Conclusion The therapeutic effect and complication rate are comparable regardless of addition of epinephrine to submucosal injection during ESD.