[1]廖美荣,王旺妃,符白玉,等.二氧化碳灌注与空气灌注内镜黏膜下剥离术治疗结直肠息肉临床疗效对比研究[J].陕西医学杂志,2023,52(8):1034-1037.[doi:DOI:10.3969/j.issn.1000-7377.2023.08.021]
　LIAO Meirong,WANG Wangfei,FU Baiyu,et al.Comparative study of clinical efficacy of carbon dioxide perfusion and air perfusion endoscopic submucosal dissection in treatment of colorectal polyps[J].,2023,52(8):1034-1037.[doi:DOI:10.3969/j.issn.1000-7377.2023.08.021]
点击复制

二氧化碳灌注与空气灌注内镜黏膜下剥离术治疗结直肠息肉临床疗效对比研究

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年8期
页码:
1034-1037
栏目:
临床研究
出版日期:
2023-08-05

文章信息/Info

Title:
Comparative study of clinical efficacy of carbon dioxide perfusion and air perfusion endoscopic submucosal dissection in treatment of colorectal polyps
作者:
廖美荣; 王旺妃; 符白玉; 符 晶; 周 菲
(海南医学院第一附属医院,海南 海口570100)
Author(s):
LIAO Meirong; WANG Wangfei; FU Baiyu; FU Jing; ZHOU Fei
(The First Affiliated Hospital of Hainan Medical College,Haikou 570100,China)
关键词:
结直肠息肉;  内镜黏膜下剥离术;  二氧化碳灌注;  腹痛;  并发症;  复发
Keywords:
Colorectal polyps;  Endoscopic submucosal dissection;  Carbon dioxide perfusion;  Abdominal pain;  Complication;  Relapse
分类号:
R 735
DOI:
DOI:10.3969/j.issn.1000-7377.2023.08.021
文献标志码:
A
摘要:
目的:探究二氧化碳灌注与空气灌注内镜黏膜下剥离术(ESD)治疗结直肠息肉的临床疗效以及对患者术后疼痛、并发症的影响。方法:纳入114例结直肠息肉患者,采用随机数表法分为观察组(57例)和对照组(57例)两组。其中观察组术中采二氧化碳灌注,对照组术中行空气灌注,对比两组患者手术相关参数、围术期围术期血流动力学指标,并发症发生情况及两组患者的预后情况。结果:两组患者手术时间、麻醉唤醒时间、息肉完全切除率以及垂直切缘阴性率等比较均无统计学差异(均P>0.05),观察组并发症总发生率低于对照组(P<0.05)。两组患者麻醉前5 min、麻醉即刻、手术开始5 min以及术毕时刻的收缩压(SBP)、舒张压(DBP)以及心率(HR)比较差异均无统计学意义(均P>0.05)。术后1、6、12、24 h,观察组腹痛视觉疼痛模拟评分法(VAS)得分均低于对照组(均P<0.05)。两组患者术后1年复发率比较无统计学差异(P>0.05)。结论:ESD在采用二氧化碳灌注可保障切除率的前提下,降低腹痛程度以及术后并发症发生的风险。同时对患者围术期血流动力学、术后复发率均无影响,相对于空气灌注而言优势显著。
Abstract:
Objective:To explore the clinical efficacy of carbon dioxide perfusion and air perfusion endoscopic submucosal dissection(ESD)in the treatment of colorectal polyps and their influence on postoperative pain and complications.Methods:A total of 114 patients with colorectal polyps were included and divided into observation group(57 cases)and control group(57 cases)by random number table method.The observation group received intraoperative carbon dioxide perfusion,and the control group received intraoperative air perfusion.The operation-related parameters,perioperative hemodynamic indexes,complications and prognosis of the two groups were compared.Results:There were no differences in operation time,anesthetic awakening time,tumor complete resection rate and negative rate of vertical resection margin between two groups(all P>0.05).The total complication rate of observation group was lower than that of control group(P<0.05).There were no significant differences in DBP,HR and SBP between two groups at 5 minutes before anesthesia,immediately after anesthesia,5 minutes after surgery and at the end of surgery(all P>0.05).At 1,6,12 and 24 hours after surgery,VAS scores in observation group were lower than those in control group(all P<0.05).There was no metastasis in two groups 1 year after surgery,and there was no difference in recurrence rate 1 year after surgery(P>0.05).Conclusion:Using carbon dioxide perfusion in ESD can reduce the degree of abdominal pain and the risk of postoperative complications on the premise of ensuring the resection rate.At the same time,it had no effect on perioperative hemodynamics and postoperative recurrence rate of patients,and had significant advantages compared with air perfusion.

参考文献/References:

[1] 徐恩盼,李 冰,周平红,等.内镜黏膜下剥离术治疗超高龄患者结直肠癌前病变及早期癌的临床疗效分析[J].中华消化内镜杂志,2021,38(12):985-990.
[2] 张 涛,丁 宁,罗 吉,等.从痰刍议腺瘤性结直肠息肉的论治[J].陕西中医,2022,43(11):1596-1599.
[3] 李沣员,宣 哲,徐 皓,等.内镜黏膜下剥离术后行全腹腔镜远端胃切除术和直接行全腹腔镜远端胃切除术治疗早期胃癌的近期疗效[J].中华消化外科杂志,2021,20(5):519-527.
[4] 王丽玉,刘晓波,郜元军,等.结直肠隆起性病变内镜下黏膜剥离术后并发症的相关研究[J].临床内科杂志,2020,37(2):130-131.
[5] 阿里木江?阿不都热合曼,纪文静,阿古再?热合曼.超声内镜诊治上消化道黏膜下病变180例临床观察[J].陕西医学杂志,2017,46(1):65-67.
[6] Ono H,Yao K,Fujishiro M,et al.Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer(second edition)[J].Dig Endosc,2021,33(1):4-20.
[7] Murphy PB,Bihari A,Parry NG,et al.Carbon monoxide and hydrogen sulphide reduce reperfusion injury in abdominal compartment syndrome[J].J Surg Res,2018,222(1):17-25.
[8] 于海琦,李 静.无痛肠镜下治疗肠息肉300例临床疗效观察[J].陕西医学杂志,2020,49(12):1600-1603.
[9] Pimentel-Nunes P,Dinis-Ribeiro M,Ponchon T,et al.Endoscopic submucosal dissection:European Society of Gastrointestinal Endoscopy(ESGE)Guideline[J].Endoscopy,2015,47(9):829-854.
[10] Jensen MP,Chen C.Brugger AM.Interpretation of visual analog scale ratings and change scores:A reanalysis of two clinical trials of postoperative pain[J].J Pain,2003,4(7):407-414.
[11] 王保健,顾文芬,胡忠卓,等.内镜下黏膜切除术与内镜黏膜下剥离术治疗消化道神经内分泌肿瘤的对比研究[J].中国内镜杂志,2017,23(9):75-78.
[12] 周震宇,王小云,龚 镭,等.内镜黏膜下剥离术衍生技术内镜黏膜下挖除术在消化道神经内分泌肿瘤中的应用[J].中国内镜杂志,2018,24(4):85-89.
[13] 龙思丹,姚树坤,杨振寰,等.姚树坤治疗消化道息肉经验介绍[J].陕西中医,2020,41(9):1295-1297.
[14] 严丽军,汤琪云,蒋建霞,等.内镜超声指导内镜黏膜下剥离术诊治直肠神经内分泌肿瘤的临床价值[J].中华消化内镜杂志,2017,34(6):405-409.
[15] 朱晓芸,马如超,于红刚.我国内镜黏膜下剥离术与外科手术治疗早期胃癌疗效Meta分析[J].中华肿瘤防治杂志,2019,26(17):1296-1305.
[16] DE M,Monte J.Endoscopic submucosal dissection and endoscopic mucosal resection:Progress,techniques,and new directions[J].Arq Gastroenterol,2021,58(2):129-130.
[17] Aihara H,Dacha S,Anand GS,et al.Core curriculum for endoscopic submucosal dissection(ESD)[J].Gastrointest Endosc,2021,93(6):1215-1221.
[18] 詹磊磊,张 侃,蔡任军,等.二氧化碳灌注在内镜黏膜下剥离术治疗结直肠肿物中的临床应用[J].中国内镜杂志,2021,27(2):41-46.
[19] 杨 春,汪小海.二氧化碳气腹相关的肝肾损伤的研究进展[J].医学综述,2019,25(10):1990-1994.
[20] 何思伟,毛小川.腹腔镜手术中麻醉及呼气末二氧化碳水平对脑血流灌注的影响分析[J].检验医学与临床,2017,14(14):2148-2149,2161.

相似文献/References:

[1]王业流,周 进,周淑萍,等.10 mm以下结直肠息肉内镜下黏膜切除术后迟发性出血影响因素及金属夹预防效果分析[J].陕西医学杂志,2024,(12):1668.[doi:DOI:10.3969/j.issn.1000-7377.2024.12.016]
　WANG Yeliu,ZHOU Jin,ZHOU Shuping,et al.Influencing factors of delayed bleeding after endoscopic mucosal resection of colorectal polyps less than 10 mm and prevention effect of metal clips[J].,2024,(8):1668.[doi:DOI:10.3969/j.issn.1000-7377.2024.12.016]

备注/Memo

备注/Memo:
基金项目:海南省卫生健康行业科研项目(22A200047)
更新日期/Last Update: 2023-08-07