Comparison of O-Type HybridKnife to Conventional Knife in Endoscopic Submucosal Dissection for Gastric Mucosal Lesions.
Comparison of O-Type HybridKnife to Conventional Knife in Endoscopic Submucosal Dissection for Gastric Mucosal Lesions.
复制标题
O型混合刀与传统刀在胃粘膜病变内镜粘膜下剥离术中的比较
DOI：
10.1097/md.0000000000003148
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发表时间：
2016-03
期刊：
影响因子：
1.6
通讯作者：
Wu K
中科院分区：
文献类型：
--
作者：
Huang R;Yan H;Ren G;Pan Y;Zhang L;Liu Z;Guo X;Wu K
摘要内镜下黏膜下剥离术（ESD）是近年来公认的治疗局限性浅表胃肠道肿瘤的一种微创方法。然而，这一程序在技术上仍然具有挑战性，而且耗时。最近开发了一种带有部分绝缘尖端的新型解剖刀，具有内置注射功能。为探讨该器械是否能提高ESD手术的效率，将78例胃黏膜病变（包括扁平型息肉、腺瘤和早期胃癌）患者随机分为O型HybridKnife和传统ESD刀两组。分析手术时间和ESD相关因素，HybridKnife组ESD手术时间为43.0（四分位数范围，IQR 27.0-60.0）min，对照组为60.5（IQR 44.0-86.3）min（P = 0.001）。 临床结局和不良事件发生率无差异。前者在样本大小<4 cm的病变（P <0.0001）和位于远端胃（P = 0.001）以及纤维化病变（P = 0.008）中表现出更有利的结果。 多变量回归分析显示，O型刀（P <0.0001）、标本大小（P <0.0001）和纤维化（P <0.0001）是手术时间的独立预测因素。在胃ESD中，O型HybridKnife的手术时间比传统刀更快，安全性相似。
AbstractEndoscopic submucosal dissection (ESD) has been accepted as a minimal invasive alternative to surgery for localized superficial gastrointestinal neoplasms recently. However, the procedure remains to be technically challenging and time consuming. A new dissecting knife with partially insulated tip has been recently developed with built-in injection capability. The purpose of this study was to investigate whether the efficiency of ESD procedure could be improved with this new device.A total of 78 patients, who underwent ESD with gastric mucosal lesions including flat type polyps, adenoma or early gastric cancer, were randomly assigned to either ESD with O-type HybridKnife or conventional ESD knives without waterjet. Procedure time and related factors of ESD were analyzed.ESD procedure time was 43.0 (interquartile range, IQR 27.0–60.0) minutes in HybridKnife group compared to 60.5 (IQR 44.0–86.3) minutes in the control group (P = 0.001). There was no difference in the clinical outcome and the adverse event rate. The former demonstrated more favorable results in lesions ⩽4 cm of specimen size (P ⩽ 0.0001) and when located in the distal stomach (P = 0.001), also in lesions with fibrosis (P = 0.008). Multivariate regression analysis showed that O-type Knife (P ⩽ 0.0001), specimen size (P ⩽ 0.0001), and fibrosis (P ⩽ 0.0001) were independent predictors of procedure time.The O-type HybridKnife yielded faster procedure time compared to the conventional knives in gastric ESD with a similar safety profile.