纵切口在胃上皮下病变内镜下黏膜下挖掘的有效性评估
April 28th, 2026
本方案描述了纵切口内镜黏膜下腔挖掘术，该技术旨在促进胃上皮下病变的切除和缺损闭合。
本研究比较了内镜下黏膜下切口的纵切口与环切口，以确定哪种方法更快且更安全。圆形切口会产生难以闭合的大面积缺口。纵向切口简化了闭合并缩短手术时间。
该技术非常适合内镜切除直径不超过2厘米的胃上皮下小病变。首先，使用一次性电手术刀沿病灶边缘沿圆形标记几个点，距离病灶边缘三到五毫米，以界定切除边界。对于靛红黏膜下注射，针头深入组织。
注射时需缓慢拔出，确保尖端仍停留在黏膜下中层。确认黏膜表面迅速、均匀且持续地抬升，形成平滑的圆顶状隆起。接着，使用一次性电手术刀沿病变中心轴在黏膜和黏膜下部进行纵切口，确保切口超过病变的整个纵向尺寸。
用电手术刀仔细切除并分离病变下方的黏膜下结缔组织。接下来，完全暴露病变，完全脱离附着物，同时尽可能保留底层肌肉。如果在分离过程中检测到出血，应使用电手术刀凝固轻微出血血管。
彻底检查切除缺损是否有活动性出血或可见血管。使用一次性电外科止血钳治疗出血点或高风险血管，以防止延迟出血。为闭合缺损，首先中等抽吸胃内气体以接近缺损边缘并减少组织间隙以便剪切。
用夹子的一侧咬合缺损近端的黏膜边缘。然后用对侧下颌钩住远端黏膜边缘。在保持持续吸力的同时关闭夹子。
接着，依次夹上粘膜边缘，直到整个缺损完全相反。在大多数基线人口统计和临床变量中，改进组与传统组之间未发现统计学显著差异。改进组的平均操作时间显著缩短于常规组。
两组均未发生严重术后并发症，如穿孔、腹部脓肿、发热或剧烈腹痛。两组重大并发症发生率均为0%，且未发现统计学上显著差异。该方案能够精确测量两种切口技术之间的手术时间、成功率及并发症情况。
关键挑战是确保纵切口正好位于病变长轴的中心。
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Overview
This article details a protocol for longitudinal incision endoscopic submucosal excavation (ESE) as an improved method for removing small gastric subepithelial lesions (SELs ≤ 2 cm). The longitudinal incision technique is compared to the conventional circular incision, demonstrating advantages in operative efficiency, defect closure, and safety.
Key Study Components
Area of Science
- Gastroenterology
- Endoscopic surgery
- Minimally invasive procedures
Background
- Endoscopic submucosal excavation (ESE) is used to manage gastric subepithelial lesions.
- Traditional circular incisions can create large defects that are difficult to close.
- Efficient closure and reduced operative time are important for patient outcomes.
- There is a need for improved techniques to optimize ESE for small gastric SELs.
Purpose of Study
- To present a detailed protocol for longitudinal incision ESE.
- To compare the longitudinal incision technique with the conventional circular incision in terms of procedural success, operative time, and safety.
- To assess the feasibility and technical outcomes of the new approach.
Methods Used
- Marking the lesion margin with dots in a circular pattern, 3–5 mm outside the lesion edge.
- Submucosal injection of indigo rouge to elevate the mucosa.
- Making a longitudinal incision along the central axis of the lesion using an electrosurgical knife.
- Dissecting and separating submucosal tissue to fully expose and free the lesion.
- Hemostasis using electrosurgical knife and hemostatic forceps as needed.
- Primary closure of the defect with sequential application of metal clips under suction.
- Retrospective comparison of outcomes between longitudinal (n=21) and circular (n=31) incision groups.
Main Results
- The longitudinal incision group achieved a 100% procedural success rate.
- Mean operation time was significantly shorter for the longitudinal group (51.43 ± 5.56 min) compared to the circular group (70.00 ± 6.96 min, P=0.0179).
- Reduced need for advanced closure devices in the longitudinal group (5% vs. 28%).
- Low complication rates in both groups, with no serious postoperative events.
Conclusions
- The longitudinal incision ESE technique is safe, effective, and feasible for gastric SELs ≤ 2 cm.
- This method offers practical advantages in operative efficiency and defect management.
- It may reduce the need for additional closure devices and consumables.
