手术室内行内镜黏膜下剥离术治疗胃肠道病变102例

Endoscopic submucosal dissection for gastrointestinal lesions in the operating room:an analysis of 102 cases

目的:初步评价在手术室内行内镜黏膜下剥离术(ESD)治疗胃肠道病变的安全性及有效性.方法:收集2008-03/2010-05共102例病例患者,内镜检查发现的胃肠道病灶患者作为入选对象,术前行染色内镜和超声内镜检查,确定病变范围和深度,常规行术前评估,手术室内行气管插管全身麻醉.观察手术时间、黏膜下注射液体量、手术前后血红蛋白水平变化、手术成功率及并发症发生率.结果:切除标本最大直径平均2.72cm±0.81cm;术中平均黏膜下注射量为35.5mL±14.05mL;手术平均手术操作时间65.91min±25.49min;手术完整剥离成功率95.1%,穿孔发生率2.9%,其中1例穿孔行外科手术治疗,1例发生迟发型出血,行手术治疗.结论:手术室内行ESD有利于降低并发症的发生率,而且有利于并发症的及时处理,可有效地规避医疗风险.

AIM：To assess the efficacy and safety of endoscopic submucosal dissection（ESD） conducted in the operating room for gastrointestinal lesions. METHODS：A total of 102 patients with gastrointestinal lesions diagnosed by endoscopy from March 2008 to May 2010 were enrolled. Chromoendoscopy and endoscopic ultrasonography were performed to confirm the extent and depth of the lesions.All the patients underwent routine preoperative evaluation.Tracheal intubation and general anesthesia were conducted in the operating room.The operation duration,volume of submucosal injection solution used,changes in blood Hb levels,and the rates of en bloc resection and complications were recorded. RESULTS：The maximum diameter of resected samples was 2.72 cm±0.81 cm.The volume of submucosal injection solution used was 35.5 mL ±14.05 mL.The average operation duration was 65.91 min±25.49 min.The en bloc resection rate was 95.1%.The perforation rate was 2.9%.Two patients received emergency surgery because of perforation and uncontrolled delayed hemorrhage. CONCLUSION：ESD conducted in the operating room is associated with less complications and permits prompt,convenient handling of complications and avoiding medical risks.