Page 112 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第44卷第8期
·1140 · Journal of Nanjing Medical University（Natural Sciences） 2024年8月

·临床研究·

牙线牵引与 IT 刀辅助内镜黏膜下剥离术治疗胃角病变的临床

对比研究

王 晨 ，殷双双 ，王建坤 ，何可心 ，王 敏 ，范志宁 ，刘 莉 1
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南京医科大学第一附属医院消化内镜科，江苏 南京 210029；南京医科大学附属肿瘤医院（江苏省肿瘤医院）内镜诊疗中
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心，江苏省肿瘤防治研究所，江苏 南京 210009
［摘 要］ 目的：研究牙线牵引辅助一次性黏膜切开刀与末端绝缘（insulated⁃tip，IT）刀辅助一次性黏膜切开刀进行黏膜下剥
离治疗胃角早癌及癌前病变的临床疗效对比。方法：选取2015年12月—2023年8月南京医科大学第一附属医院收治的146例
早期胃角黏膜病变患者为研究对象，按照治疗方案分为牙线牵引组（n=73）与IT刀组（n=73），对两组手术时间、病灶剥离时间、
肌层损伤、手术效果及术后并发症情况进行评价和比较。结果：牙线牵引组肌层损伤及止血夹的使用数量相比IT刀组显著减
少（P < 0.05）。牙线牵引组的病灶整块切除率、R0切除率、治愈性切除率、切缘阳性率及围手术期并发症发生率（术后出血、穿
孔）与IT刀组比较差异无统计学意义（P > 0.05）。单因素Logistic回归分析显示，牙线牵引辅助一次性黏膜切开刀进行黏膜下
剥离能够有效减少肌层损伤（OR=0.37，95%CI：0.18~0.74，P=0.006）。结论：对于胃角早癌及癌前病变，采用牙线牵引辅助一次
性黏膜切开刀进行内镜黏膜下剥离术能够有效减少肌层损伤，确保手术的安全性和有效性。
［关键词］ 胃角早癌；癌前病变；牙线牵引；IT刀；内镜黏膜下剥离术
［中图分类号］ R656.6 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）08⁃1140⁃06
doi：10.7655/NYDXBNSN240140

Clinical comparative study of dental floss traction and IT knife assisted endoscopic

submucosal dissection in the treatment of gastric horn lesions
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WANG Chen ，YIN Shuangshuang ，WANG Jiankun ，HE Kexin ，WANG Min ，FAN Zhining ，LIU Li 1
1 Department of Digestive Endoscopy，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；
Department of Digestive Endoscopy，the Affiliated Cancer Hospital of Nanjing Medical University（Jiangsu Cancer
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Hospital），Jiangsu Institute of Cancer Research，Nanjing 210009，China
［Abstract］ Objective：To study the clinical effects of dental floss traction assisted submucosal dissection and IT knife assisted
disposable mucosal dissection knife in the treatment of early gastric horn cancer and precancerous lesions. Methods：One hundred and
forty⁃six patients with early gastric horn cancer and precancerous lesions admitted from December 2015 to August 2023 were included
as study subjects. They were divided into two groups according to the treatment plan：dental floss traction group（n=73）and IT knife
group（n=73）. The time of operation and lesion dissection，muscularis injury，surgical effect，and postoperative complications in the
two groups were evaluated and compared. Results：The number of muscularis injury and the use of hemostatic clips were significantly
reduced in the dental floss traction group compared to the IT knife group（P < 0.05）. There was no significant difference in the whole
lesion resection rate，R0 resection rate，curative resection rate，margin involvement rate，and perioperative complication rate
（postoperative bleeding and perforation）between the two groups（P > 0.05）. Univariate analysis showed that floss traction⁃assisted
submucosal dissection with disposable mucosal dissection knife was effective in reducing muscularis injury（OR=0.37，95%CI：0.18-
0.74，P=0.006）. Conclusion：The use of dental floss assisted endoscopic submucosal dissection for early gastric horn cancer and
precancerous lesions is particularly effective. It can significantly reduce the damage to the muscularis propria and ensure the safety and
effectiveness of the procedure.
［Key words］ early gastric horn cancer；precancerous lesion；dental floss traction；IT knife；endoscopic submucosal dissection
［J Nanjing Med Univ，2024，44（08）：1140⁃1145］