内镜下黏膜切除术治疗消化道平坦型病变103例分析

Analysis of 103 cases of endoscopic mucosal resection for treatment of gastrointestinal flat lesions

目的回顾分析内镜下黏膜切除术（EMR）对消化道平坦型病变的治疗效果，并讨论其并发症和操作方法。方法103例共114处消化道平坦型病变，以注射法或透明帽辅助法行黏膜切除治疗，记录其操作方法、并发症、术后病珲类型及随访情况。结果113处病变经EMR或EPMR完整切除，治愈率99．12％。并发症：术中出血7例（6．80％），以APC止血成功。术后迟发出血1例（0．97％），内科保守治疗成功，无穿孑L发生。术后病理：良性腺瘤73处，黏膜肌层平滑肌瘤5处，乳头状瘤2处，增生性息肉11处，炎性息肉17处，黏膜内癌（m癌）3处，黏膜下层癌（sml癌）2处，同有肌层癌（nap癌）1处。sml癌追加外科肠段切除，手术标本未见肿瘤残存或浸润。mp癌行黏膜下注射后抬举征可疑阳性，术后追加外科肠段切除，可见肠旁淋巴结转移（1／6）。癌变病例随访3～9月，未见病变残留或复发。结论镜下黏膜切除术可安全有效切除大多数消化道平坦型病变。〉10min病变术后应常规作病理检查。采用纯切模式，较大功率有助于保持标本完整性。

Objective To analyze the curative effect of endoscopic mucosal resection （EMR） on gastrointestinal flat lesions and to discuss its complications and applications. Methods EMR were performed on 103 patients with 114 flat lesions by analyzed injection or cap-assisted method. The procedures and complications were recorded. All resected specimen were analyzed pathologically. The follow-up investigation was recommended for all cases. Results One hundred and thirteen lesions were completely resected by EMR or EPMR. The curative rate was 99. 12%. The complications were showed as following ： seven cases （6.80%） of hemorrhage during procedure were easily cured by argon plasma coagulation （APC）. One delaying hemorrhage （0.97%） was cured by medication. No perforation occurred. The post-EMR pathological anlysis revealed 73 lesions of benign adenomas, 5 lesions of mueomuscular leiomyomas, 2 lesions of mastoid Tumors, 11 lesions of hyperplastie polyps, 17 lesions of inflammatory polyps, 3 lesions of intramucosal carcinomas, 2 lesions of sml carcinomas, 1 lesions of mp carcinoma. Two cases of sml carcinomas were transferred for further surgery treatment, and no residual tumors were detected in futher resected tissues. Suspicious lifting sign was developed in one case of mp carcinoma during EMR, and adjacent lymphoid metastasis （1/6） was detected in later surgery. There was no remnant or recurrent. Tumors detected during the 3 - 9 months follow-up of all carcinomatous cases. Conclusion EMR is a safe and effective treatment for many gastrointestinal flat lesions. Post-EMR pathological assessment should be applied in those lesions that were larger than 10 mm in diameter. Pure incision mode and higher power help to keep the histological integrity of resected specimen. [ Key words ]