摘要目的: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)cm 2，较传统ESD组的6.90(5.50，13.50)cm 2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)cm 2/min比0.52(0.30，0.62)cm 2/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。

abstractsObjective: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) cm 2 VS 6.90 (5.50, 13.50) cm 2, 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) cm 2/min VS 0.52 (0.30, 0.62) cm 2/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.