Department of Surgery, Institute of Gastroenterology, Tokyo, Japan.
Dig Endosc. 2012 Sep;24(5):315-8. doi: 10.1111/j.1443-1661.2012.01286.x. Epub 2012 Apr 2.
The usefulness of clip traction in endoscopic submucosal dissection (ESD) for early esophageal carcinoma was investigated.
A total of 87 patients who underwent ESD for esophageal squamous cell carcinoma were included in the study. The hook knife method was used for ESD. Twenty patients underwent ESD without clip traction (non-clip group) and 67 underwent procedures in which clip traction was used (clip group). A clip with a string was attached to the oral edge of the lesion after mucosal incision in the clip group.
ESD was successful in all cases. Wide exposure of the submucosal tissue below the lesion was obtained by applying tension to the clip traction. The duration of ESD was shorter in the clip group, and there was a significant difference in duration between the non-clip and clip groups. There were no complications of ESD in the clip group, but muscle layer injury occurred in three patients in the non-clip group.
Clip traction shortens operating time and is safer in esophageal ESD. Clip traction is recommended as a useful auxiliary procedure.
探讨夹牵引在内镜黏膜下剥离术（ESD）治疗早期食管癌中的作用。
本研究共纳入 87 例接受食管鳞癌 ESD 治疗的患者。ESD 采用钩刀法。20 例患者行 ESD 时未行夹牵引（非夹组），67 例行夹牵引（夹组）。夹组在黏膜切开后于病变口侧边缘附加带线夹。
所有病例 ESD 均成功。夹牵引施加张力，使黏膜下组织下的组织广泛暴露。夹组 ESD 时间更短，非夹组和夹组间 ESD 时间差异有统计学意义。夹组无 ESD 相关并发症，而非夹组有 3 例发生肌层损伤。
夹牵引可缩短手术时间，在食管 ESD 中更安全。夹牵引作为一种有用的辅助方法，推荐使用。
