ABSTRACT
Objective To compare the safety and efficacy of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection ( ESD) for treatment of esophageal superficial neoplasms. Methods A retrospective study was performed on data of patients with esophageal superficial neoplasms who were treated by conventional ESD or ESTD at Xijing Hospital of Digestive Diseases between January 2014 and December 2016. The procedure time, pathology, rate of en bloc resection and curative resection, and adverse events were compared between the two groups. Results A total of 113 consecutive patients were collected, including 49 undergoing ESTD and 64 undergoing ESD. ESTD had a shorter procedure time than ESD method [38. 0 min(21. 4-71. 0 min) VS 46. 5 min(32. 5-117. 5 min), P＝0. 008],and the dissection speed of ESTD was faster than that of ESD[0. 42 cm2/min(0. 22-0. 59 cm2/min) VS 0. 34 cm2/min(0. 20-0. 42 cm2/min), P＝0. 000]. There were no statistical differences in the en bloc resection rate ( 100. 0% VS 100. 0%, P＝1. 000) or the curative resection rate (98. 0% VS 93. 8%, P＝0. 386).There were no statistical differences on adverse event rates including post-procedure bleeding, perforation, fever, and thoracalgia.ESTD group showed a lower rate of muscular injury (20. 4% VS 39. 1%, P＝0. 041) and intra-procedure bleeding (18. 4% VS 37. 5%, P＝0. 036). A multivariate regression analysis for procedure time showed that ESTD method ( OR＝ 2. 801, 95%CI: 1. 116-7. 031, P＝0. 028) and lesion area ＜9 cm2(OR＝5. 049, 95%CI: 2. 088-12. 208, P＝0. 000) were associated with a shorter procedure time.Conclusion ESTD is safe and effective for treatment of esophageal superficial neoplasms. It can shorten operative time, improve dissection speed, and reduce intra-procedure muscular layer injury and bleeding.
ABSTRACT
ObjectiveTo observe the effects of different angles between tibial tunnel and tibial platform on “killer turn” in posterior cruciate ligament (PCL) reconstruction,and primarily discuss a safe and reasonable tunnel technology. Methods Eighteen fresh tendon grafts were used to reconstruct the PCL on the tibial side of fresh cadavers.The tibial tunnels of all specimens were built via anteromedial approach.Based on the different angles between tibial tunnel and tibial platform,all specimens were divided into Group A (30°),Group B (40°) and Group C (50°),with six specimens in each group.Area of tibial tunnel exit,pressure of tibia tunnel exit and circulation characteristics of tendons under the cyclic load before and after biomechanical test were recorded.ResultsThe area of tibial tunnel exit had statistical difference among three groups after the test ( F =8.80,P ＜ 0.05 ).The pressure of tibial tunnel exit had statistical difference among three groups (F =3.91,P ＜ 0.05 ).The cyclic frequency and fatigue strength of the transplanted tendons had statistical difference among three groups under the same cyclic load ( 256 N ) and same frequency ( 126 Hz ) ( F =4.25,P ＜ 0.05 ).Conclusions The angle between tibial tunnel and tibial platform has negative correlation with the area and pressure of tibial tunnel exit,and has positive correlation with the cyclic frequency and fatigue strength of the transplanted tendons under cyclic load.The ideal anatomy position of the tibial tunnel is the anteromedial tunnel with the angle of 40° between the tibial tunnel and the tibial platform.