经口牙线牵引辅助内镜下黏膜剥离术治疗早期胃癌的效果及学习曲线分析

目的探讨经口牙线牵引辅助内镜下黏膜剥离术(ESD)治疗早期胃癌的效果及学习曲线。方法将2017年1月至2019年10月于我院行ESD治疗的早期胃癌患者126例进行前瞻性分析。按照随机数字表法分为常规组和牙线牵引组,每组63例。常规组给予常规ESD治疗,牙线牵引组给予经口牙线牵引辅助ESD治疗。比较2组患者的操作时间、整块切除率、完整切除率、术中出血量和并发症发生率;每组按时间顺序分为2个阶段,以单位时间内切割面积和手术时间评价学员学习曲线的变化。结果牙线牵引组的操作时间、术中出血量和并发症发生率均少于常规组,差异有统计学意义(P<0.05);整块切除率和完整切除率均高于常规组,差异有统计学意义(P<0.05)。学习曲线结果显示,2组的单位时间内切割面积随着手术例数的增多而增加,且牙线牵引组增加更明显;2组的手术时间随着手术例数的增多而减少,且牙线牵引组减少更明显。结论经口牙线辅助ESD治疗早期胃癌安全、有效,不仅可减少了操作时间、术中出血量及并发症发生率等,而且操作者容易学习、操作更稳定。

Effect and learning curve analysis of oral floss traction assisted endoscopic mucosal dissection in the treatment of early gastric cancer

Objective To investigate the efficacy and learning curve of endoscopic mucosal dissection(ESD)with oral floss traction in the treatment of early gastric cancer.Methods A prospective analysis was conducted on 126 patients diagnosed as early gastric cancer in our hospital from January 2017 to October 2019 and treated with ESD.According to the random number table method,all the patients were divided into the conventional group and the floss traction group,with 63 cases in each group.The conventional group was given conventional ESD treatment,the floss traction group received ESD treatment assisted by oral floss traction.The operation time,en bloc resection rate,complete cut rate,intraoperative blood loss and complication rate of the two groups were compared.At the same time,each group was divided into 2 stages according to the time sequence,and the change of learning curve was evaluated by cutting area and operation time per unit time.ResultsThe operation time,intraoperative blood loss and complication rate of the floss traction group were lower than those of the conventional group,and the differences were statistically significant(P<0.05).However,the en bloc resection rate and the complete cut rate of the floss traction group were higher than those in the conventional group,and the differences were statistically significant(P<0.05).The learning curve results showed that the cutting area per unit time of the two groups increased with the increase of the number of cases,and the increase was more obvious in the floss traction group.The operation time of the two groups decreased with the increase of the number of cases,and the reduction was more obvious in the floss traction group.Conclusion Oral flossing assisted ESD is safe and effective in the treatment of early gastric cancer,which not only reduces the operation time,intraoperative blood loss and the incidence of complications,but also makes the operation easier to learn and more stable.