内镜黏膜下剥离术(ESD)治疗消化道病变

Endoscopic submucosal dissection of digestive tract lesions

目的探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗消化道病变的疗效、安全性及并发症防治。方法回顾性分析ESD方法治疗29例(共31块)消化道病变的内镜下手术情况、并发症及治疗、预后情况。结果术中出血2例,1例创面小动脉出血,内镜下钛夹止血,另1例胃黏膜下持续出血,形成血肿,中转开腹行胃窦切除术;1例直肠管状腺瘤ESD术后7天大出血,经肛门缝扎止血;术中发现肠壁穿孔1例,中转开腹行肠壁修补术。29例患者均痊愈出院,无1例留下后遗症,平均住院时间5 d。随访2～27个月未见复发。结论 ESD治疗消化道病变是安全的,可以一次性完整切除较大病变,提供完整的病理学资料,且术后不易复发。缺点是操作时间长,技术难度较大,并发症较EMR多。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection（ESD） for the gastrointestinal tract diseases.Methods 29 cases of gastrointestinal tract diseases treated with endoscopic submucosal dissection were analyzed retrospectively,including operation situation under endoscopy,complication and treatment,prognosis.Results Two patients had massive hemorrhage during ESD.One was treated with a titanium clip,and the other was managed surgically（resection of antrum）.One of the patients had delayed bleeding 7 days after ESD,which was ceased by suture and ligation through anus.Intestinal perforation happened in another case,who was subjected to intestinal repair.The average postoperative length of stay was 5 days,patients were discharged without sequela and no recurrence was observed in 2~27 months follow-up visit.Conclusion ESD is an efficacious and safe procedure for the treatment of gastrointestinal tract diseases.It is possible to completely resect lesions and provide sufficient pathological information.However,ESD is time consuming and technically difficult,usually results in more complications than EMR.