内镜下黏膜剥离术治疗消化道早癌及癌前病变24例临床分析

Experience of endoscopic submucosal dissection (ESD) for 24 cases of gastrointdestinal early stage cancer or previous cancer lesion.

目的观察内镜下黏膜剥离术(ESD)对消化道病变的治疗效果。方法2006年11月至2008年6月,中国人民解放军总医院消化科内镜中心ESD治疗消化道病变24例。观察其疗效及并发症发生情况。结果24例患者病变全部切除成功,操作时间36～165 min,平均75.7 min。其中,胃窦体病变操作时间41～81 min,平均60.1 min;2个胃底部病变耗时分别为114 min和118 min,平均116.0 min;食管病变操作时间39～102 min,平均63.7 min;大肠病变36～165 min,平均83.8 min。无术中出血、穿孔并发症发生,术后迟发出血1例,内镜下止血成功,出血率为4.1%。患者住院天数5～19 d,平均8.8 d。所有病例均纳入内镜随访计划,随访时间最长12个月,最短1个月。随访结果,复发1例,复发残留率4.2%。结论ESD虽然有操作过程复杂、操作技巧难度大等缺点,但对于消化道早期肿瘤以及黏膜病变具有整块切除率高、复发率较低、并发症少等优点,值得推广。

Objective To test the effect of endoscopic submucosal dissection （ESD） on gastrointdestinal early stage cancer or previous cancer lesion. Methods 24 cases in Department of Gastroenterology, General Hospital of Chinese PLA were treated in our unit by ESD methods from Nov. 2006 to Jun. 2008, the effect and complication was observed. Results All 24 lesions were removed successful. The operative time was between 36 to 165 minutes and the average is 75.7 minutes, Among the total, Antrum and body was between 41 -81 minutes and averaged 60. 1 minutes, the fundus of stomach was between 114 - 118 minutes and averaged 116. 0 minutes, the esophageal was between 39 - 102 minutes and averaged 63.7 minutes and colon was between 36 - 165 minutes and averaged 83. 8 minutes. There was no complications during the procedure and only 1 （4. 1% ）ease was late onset bleeding which stopped successful by endoscopy. The patients were hospitalization among 5 - 19 days and average 8. 8 days. All the patients were follow up for 1 - 12 months by endoscopy. Now l patient have relapsed and the residual rate is 4. 2%. Conclusion Although the ESD is complex procedure and difficult technique,it have high en bloc resection rate,low residual rate and few complications with early digestive cancer and mucosal lesion, this technique should be used widely.