与传统绝缘头刀相比，一步刀用于内镜黏膜下剥离术的有效性和安全性：一项收集前瞻性数据和进行回顾性分析的初步研究

Efficacy and safety of one-step knife compared to conventional insulated-tip knife for endoscopic submucosal dissection: a preliminary study with prospective data collection and retrospective review.

作者信息

Ryu Dae Gon, Kim Su Jin, Choi Cheol Woong, Kang Dae Hwan, Kim Hyung Wook, Park Su Bum, Nam Hyeong Seok

机构信息

Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, Korea.

出版信息

Surg Endosc. 2023 Jan;37(1):329-336. doi: 10.1007/s00464-022-09515-0. Epub 2022 Aug 8.

DOI:10.1007/s00464-022-09515-0

PMID:35941308

Abstract

BACKGROUND

Endoscopic submucosal dissection (ESD) is not as tiresome as gastrectomy, but it is a time-consuming procedure. One-step knife (OSK) is a novel knife that combines a knife for ESD and an injection needle into one sheath. In this study, we aimed to compare the insulated tip type of OSK and conventional knife (CK) in terms of procedure time and complication rate.

METHODS

Medical records of patients with ESD using CK between February and September 2020 were retrospectively reviewed. Subsequently, data from patients who underwent ESD using OSK by September 2021 were prospectively collected. Total procedure time, procedure time by location and complication rate in the OSK and CK group were compared.

RESULTS

In the study period, a total of 203 patients (OSK, 102 patients; CK, 101 patients) were analyzed. On multivariate analysis, using CK, body location, resection size ≥ 40 mm, and submucosal fibrosis were associated with longer procedure time. The total procedure time was statistically significantly reduced in the OSK group (median 11 vs. 17 min, p < 0.01). The procedure time for each location was more reduced in the body (median 14 vs. 19 min p < 0.01) than the antrum (median 10 vs. 14 min, p = 0.01) in the OSK group. There was no significant difference in post-ESD bleeding and perforation in the two groups (3.9 vs. 3.9%, p = 0.99 and 1.0 vs. 2.0%, p = 0.56).

CONCLUSIONS

OSK significantly reduced the total procedure time of ESD. OSK could be an effective and safe knife for gastric ESD, especially for body lesions.

摘要

背景

内镜黏膜下剥离术（ESD）不像胃切除术那样繁琐，但却是一个耗时的手术。一步刀（OSK）是一种新型刀具，它将用于ESD的刀和注射针组合在一个鞘管中。在本研究中，我们旨在比较OSK的绝缘尖端型与传统刀（CK）在手术时间和并发症发生率方面的差异。

方法

回顾性分析2020年2月至9月期间使用CK进行ESD的患者的病历。随后，前瞻性收集截至2021年9月使用OSK进行ESD的患者的数据。比较OSK组和CK组的总手术时间、按部位划分的手术时间以及并发症发生率。

结果

在研究期间，共分析了203例患者（OSK组102例；CK组101例）。多因素分析显示，使用CK、身体部位、切除尺寸≥40mm以及黏膜下纤维化与更长的手术时间相关。OSK组的总手术时间在统计学上显著缩短（中位数11分钟对17分钟，p<0.01）。OSK组中，身体部位的每个部位的手术时间比胃窦部减少得更多（中位数14分钟对19分钟，p<0.01）（中位数10分钟对14分钟，p=0.01）。两组ESD术后出血和穿孔情况无显著差异（3.9%对3.9%，p=0.99；1.0%对2.0%，p=0.56）。