内镜下黏膜切除术治疗消化道浅表肿瘤

Endoscopic mucosal resection in the treatment of the gastrointestinal superficial tumors

目的探讨内镜下黏膜切除术(EMR)对消化道浅表肿瘤的治疗效果。方法选择符合EMR适应证的166例患者,部分用超声内镜(EUS)探查证实病变浸润深度未超过黏膜层,应用EMR切除了184处病变,对手术发生的并发症进行观察和处理。结果EMR前123例患者行EUS检查,占74%。EMR切除病变184处,完全切除169处,完全切除率达91.8%。术后病理诊断鳞癌2例,腺癌3例,小细胞癌1例,腺瘤或息肉伴重度异型增生6例,伴中度异型增生18例,伴低度异型增生21例,腺瘤不伴异型增生8例,平滑肌瘤63例,间质瘤13例,炎性息肉6例,幼年型息肉1例,增生性息肉41例,异位胰腺1例。并发症包括出血和穿孔,发生出血22例占13.3%,其中发生在EMR中/后24 h内的早期出血16例(73%),24 h后的延迟出血6例(27%)。并发穿孔1例,经外科急诊手术治疗好转。随访1～36个月,无1例复发或癌变。结论内镜黏膜切除术治疗浅表肿瘤安全有效,尤其是对伴有其他严重疾病的老年患者,效果好、易操作、较安全,值得临床推广和深入研究。

Objective To study the valuation of the endoscopic mucosal resection（EMR） in the treatment of the gastrointestinal superficial tumors.Methods 166 cases were selected according to EMR indication,partial of the patients accepted endoscopic untrasonography（EUS） examination to detect the extent and layers.EMR therapy were applied to resect 184 lesions,and their complications were observed and dealt with.Results 123（74%） cases received EUS before EMR.184 lesions were resected and 169 loci were totally resected（accounting for 91.8%）.Post-operation pathologic result showed 2 cases squamous cancer,3 cases adenoma cancer,1 case small cell cancer,6 cases ademomas or polyps accompanied by severe dysplasia,18 cases by moderate dysplasia,21 cases by lower dysplasia,8 cases adenoma without dysplasia,63 cases leimyoma,13 cases interstitial tumor,6 cases inflammatory polyps,1 case juvenile polyp,41 cases hyperplastic polyp,and 1 case heterotopic pancreas.Complications inncluded bleeding and perforation.22 cases bleeded（13.3%）,with 16 cases happened within 24 hours and 6 cases after 24 hours.One post-operation perforation occurred,but improved after emergency operation.During the 1 to 36 months＇ follow-up,no recurrence or depravation happened.Conclusion EMR is a safe and effective method to treat the superficial lesions of gastrointestinal tract,especially to those aged patients who are complicated with severe diseases.