内镜粘膜下剥离术治疗消化道病变29例分析

Endoscopic submucosal dissection for Gastrointestinal disease: an analysis of 29 cases

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗局部消化道病变(Gastrointes-tinal disease,GI)的疗效和安全性。方法对内镜发现的29例消化道病变(食管4例、胃13例、十二指肠1例、结肠5例、直肠6例)进行超声内镜检查后(6例病变位于黏膜层、2例病变位于黏膜肌层、9例病变位于黏膜下层、12例位于固有肌层),应用Hook Knife和IT-2 Knife进行ESD治疗。结果 24例成功完成ESD治疗,完整切除率达83%,病变最大直径0.4～5.0cm(平均2.7cm),手术时间15～145 min(平均75.5 min)。无1例出现术中内镜难以控制的大出血及术后迟发性出血;无1例出现皮下气肿、消化道瘘和胸腔腹腔继发感染;术中消化道穿孔3例(胃窦、胃底和十二指肠),转外科急症开腹手术;术中发现1例病变部分突出腔外(胃底)和1例病变已向深部浸润(胃窦),也转外科手术。所有ESD剥离病变包膜完整,基底和切缘未见病变累及。术后随访15例,无1例病变残留和复发。结论 ESD治疗消化道病变安全、有效,可以一次性完整切除病变,提供完整的病理学诊断资料。

Objective To assess the clinical efficacy and safety of endoscopic submucosal dissection（ESD）for Gastrointestinal disease（GI）.Methods The 29 cases with GI（4 cases in esophageal,13 cases in the stomach,1 cases in the duodenum,5 cases in the colon and 6 cases in the rectum）after endoscopic ultrasonography check（6 patients with pathological changes in the mucosa,2 cases of lesions in the muscularis mucosa,9 cases of lesions in the submucosa and 12 patients in muscularis propria）,the Hook Knife and IT-2 Knife were used for ESD treatment.Results 24 cases were successfully treated with ESD,and complete excision rate with 83%,the biggest diameter lesions from 0.4 to 5.0 cm（average 2.7 cm）,operation time 15~145min（average 75.5 min）.No one was found intraoperative hemorrhage difficult to control bleeding and postoperative late-occurred;No one was found subcutaneous emphysema,enteron fistulas and chest celiac secondary infection;3 cases with intraoperative gastrointestinal perforation（the gastric antrum,stomach and duodenum）were shifted to surgical department for open surgery;1 case was found that lesions were overhung the cavity（stomach bottom）and 1 case was deep infiltration（the gastric antrum）,he also shifted to surgical department for surgery.All ESD stripping coated complete lesions,basement and the cut edge were not subject to lesions.Follow-up of 12 cases,no one was lesions residue and recurrence.Conclusion GI with ESD treatment is safe,effective and can be one-time complete diseased,provide complete pathological diagnosis material.