摘要
目的 本研究旨在评价在食管内镜经黏膜下隧道肿瘤切除术（STER）中使用含有玻璃酸钠的混合液行黏膜下注射的疗效与安全性。方法 选取2020年1月至2023年10月期间42例食管黏膜下肿瘤（SMT）患者参与本项研究。患者按随机对照原则分为试验组（n=21）和对照组（n=21）。试验组采用玻璃酸钠注射液5ml（50mg）＋甘油果糖氯化钠注射液25ml＋亚甲蓝注射液0.1ml混合液作为黏膜下注射液。对照组则使用甘油果糖氯化钠注射液30ml＋亚甲蓝注射液0.1ml混合液作为黏膜下注射液。于食管SMT口侧5cm处开始用混合液进行黏膜下注射，直至黏膜有效抬举后行STER手术。结果 STER切除标本平均直径在试验组为（1.9±1.3）cm，对照组为（2.0±1.1）cm，差异无统计学意义（P>0.05）。试验组平均手术时间为（70.05±9.93）min，显著短于对照组的（96.29±12.15）min（P<0.05）。试验组平均黏膜下注射液用量为（13.52±2.77）ml，明显低于对照组的（ 26.38 ± 3.47）ml（P<0.05）。术中出血量<5ml者中，试验组有18例（86%），对照组有4例（19%）；>5ml者中，试验组有3例（14%），对照组有17例（81%），差异具有统计学意义（P<0.05）。结论 采用含有玻璃酸钠的混合液进行黏膜下注射后行STER手术，不仅疗效佳，而且安全性高。
关键词： 内镜经黏膜下隧道肿瘤切除术；黏膜下注射液；玻璃酸钠；疗效
Abstract
Objective This study aimed to evaluate the efficacy and safety of submucosal injection using a mixture containing sodium hyaluronate in submucosal tunneling endoscopic resection (STER) for esophageal submucosal tumors (SMTs). Methods A total of 42 SMT patients between January 2020 and October 2023 participated. Patients were randomly divided into the experimental group (n=21) and the control group (n=21). The experimental group received a mixture of 5ml sodium hyaluronate injection (50mg) + 25ml fructose sodium chloride injection + 0.1ml methylene blue injection as submucosal injection. The control group received 30ml fructose sodium chloride injection + 0.1ml methylene blue injection. Submucosal injection was performed from 5cm proximal to the SMT in the esophagus until effective mucosal elevation for subsequent STER surgery. Results The average diameter of resected specimens in the experimental group (1.9±1.3 cm) showed no statistically significant difference compared to the control group (2.0±1.1 cm, P>0.05). The average operation time in the experimental group (70.05±9.93 min) was significantly shorter than the control group (96.29±12.15 min, P<0.05). The average submucosal injection volume in the experimental group (13.52±2.77 ml) was significantly lower than the control group (26.38±3.47 ml, P<0.05). In cases with bleeding <5ml, the experimental group had 18 cases (86%), while the control group had 4 cases (19%); in cases with bleeding >5ml, the experimental group had 3 cases (14%), and the control group had 17 cases (81%), showing a statistically significant difference (P<0.05). Conclusion Submucosal injection using a mixture containing sodium hyaluronate for STER surgery is not only effective but also associated with high safety.
Key words： Endoscopic submucosal tunnel tumor resection; Submucosal injection; Sodium hyaluronate; curative effect
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