25例消化道病变ESD治疗体会

Practicability and Safety of Endoscopic Submucosal Dissection in 25 Cases with Gastrointostinal Lesions

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)处理消化道病灶的实用性及安全性。方法对7例消化道早期癌肿及18例深度未超过黏膜下层的黏膜下肿瘤共25例行ESD治疗。结果 25例患者均一次性完整切除病灶。所有治疗中均伴有术中出血,用ESD专用热止血钳、APC、金属止血夹成功止血,未发生术后迟发出血。术中穿孔1例,穿孔率为4%(1/25),以金属夹成功夹闭,无术后迟发穿孔。术后随访20例(包括7例消化道早期癌肿及13例黏膜下肿瘤),随访期为7～17个月(平均12.2个月),随访创面均完全愈合,未见复发病灶。结论ESD作为一种微创治疗方法,对于浸润深度不超过黏膜下层的病灶可以一次性大块剥离,从而获得完整的病理学诊断资料,安全性较好。但操作过程复杂,技术难度高。

Objective To evaluate the practicability and safety of the technique of endoscopic submucosal dissection （ESD） in gastrointestinal lesions. Methods ESD was performed in 25 patients（ include 7 early gastroinetstinal carcinomas and 18 submucosal tumors without submucosal infiltration）. Result 25 patients were dissected successfully through endoscopy. In- traoperative bleeding occurred in all lesions,which was ceased by electric doagulation, argon plasma coagulation and clamps. No delayed bleeding occurred. The intraoperative perforation occurred in one patient（ gastric antrum ectopic pancreas）, the perfora- tion rate of ESD was 4% （ 1/25 ） , and was sealed by endoclips. No delayed perforation occurred. 20 patients, including 7 early gastrointestimal carcinomas and 13 submucosal tumors, were followed up after ESD for 7 to 17 months （mean = 12.2）, and healed with no residue or recurrence. Conclusion ESD was a minimally invasive method,with which large mucosal or submu- cosal lesions can be resected and pathological information can be provided.