内镜下粘膜切除术治疗消化道隆起型病变

Endoscopic mucosal resection in therapy of gastrointestinal protrusive lesions

目的总结内镜下粘膜切除术（EMR）治疗消化道隆起型病变的经验。方法72例患者经内镜检查发现消化道隆起型病变，并明确病变源于粘膜层或粘膜下层，确定患者无手术禁忌证后，择期选择单独直接圈套切除或EMR—L或EPMR或联合以上方法切除病变。病变标本固定、标注后送病理检查。结果EMR耗费时间为15～70分钟，平均为（30±3．1）分钟。病理结果为：息肉、粘膜肌层来源的平滑肌瘤、黄斑瘤、Peutz—Jeghers综合征、低＼高级别上皮内或粘膜内瘤变、异住胰腺、LST、类癌、纤维瘤。所有高级别上皮内或粘膜内瘤变的病理标本均未发现离切缘2mm内范围内存在瘤变灶。术后有2例患者发生急性和1例延迟出血，相应止血治疗后出血停止。术后无穿孔或管腔狭窄出现。结论EMR是治疗消化道隆起型病变微创、安全、有效的手段。

Objective To summarize the experience of therapy of gastrointestinal protrusive lesions with endoscopic mucosal resection （EMR）. Methods The gastrointestinal protrusive lesions of 72 patients were proved to originate from the mucosa or submucosa by endoscopy and ultrasonic endoscopy. The patients without contraindications were treated with EMR. The specimens were fixed, labeled and sent to pathological examinations. Results The time-consuming of EMR was 30±3. 1 minute. The pathologic results were polypus, leiomyoma （origin from the muscularis mucosa）, xanthoma, Peutz-jeghers syndrome, low or high-level intraepithelial／intramucosal neoplasia, ectopic pancreas, laterally spreading tumor, carcinoid and fibroma. No neoplasia loci were found in the range of 2mm to the margin of neoplasial specimens. Acute and delay bleeding occurred in 2 and 1 patients, respectively. No perforation and stricture occurred. Conclusion EMR is minimally invasive, safe and effective for therapy of gastrointestinal protrusive lesions.