内镜黏膜下剥离术治疗胃巨大平坦病变

Endoscopic submucosal dissection in treatment of large flat gastric lesions

目的探讨内镜黏膜下剥离术(ESD)治疗胃巨大平坦病变的应用价值。方法对胃镜发现≥2cm的胃平坦病变应用头端弯曲的针形切开刀进行ESD治疗.其操作步骤为:①黏膜下注射0.9%氯化钠溶液抬高病变,使病变与肌层相分离;②预切开病变周围黏膜;③剥离病变下方黏膜下层结缔组织,完整切除病变。结果5例胃平坦病变中.3例位于胃窦,1例位于胃体,1例位于胃角。病变直径2.0～5.0cm,全部1次大块、完整剥离成功。ESD手术时间为80～120 min。术中出血量平均为100 ml,均经电凝、氩离子血浆凝固和止血夹成功止血.未出现需再次内镜下治疗的出血。术后出血1例。无一例发生消化道穿孔。所有病变均经病理确诊.基底和切缘未见病变累及。术后随访1～6个月,创面基本愈合,无一例病变残留和复发。结论ESD是治疗胃巨大平坦病变的新方法,不仅能完整切除较大的病变。还能提供完整的病理学诊断资料。

Objective To evaluate the therapeutic value of endoscopic submucosal dissection（ESD） for large flat gastric＇lesions. Methods Large flat gastric lesions （ ≥ 2 cm ） were dissected with a curved needle knife following： Oinjecting normal saline into the submucosa to separate.the lesion from＇the muscle layer; Qpre-cutting the surrounding mucosa of the lesion, and Qdissecting ihe connective tissue of the submucosa under the lesion. Results Five flat gastric lesions ranged from 2.0 to 5.0 cm were removed successfully. Three located in the antrum,1 in the body and 1 in the incisure： The procedure time ranged from 80 to 120：min . Average blood loss was about100 ml. The bleeding was controlled＇by electrocoagulation, argon plasma coagula.tion and clip. One patient had delayed bleeding after ESD. There was no perforation. There were clear resection margins confirmed by pathology in all 5 cases. The patients were followed up for 1-6 months . There were no recurrence with complete healing of original lesions. Conclusions ESD is a useful endoscopic method in treating large flat gastric lesion, h can completely remove large lesion and provide precise pathological diagnosis.