内镜粘膜下剥离术或挖除术治疗上消化道疾病的体会

Experience of endoscopic submucosal dissection (ESD) or evidement treating lesions of upper digestive tract

目的探讨内镜粘膜下剥离术(endoscopic submucosal dissection,ESD)或挖除术治疗上消化道疾病的疗效、安全性及并发症。方法分析2012年1月～2013年3月在我院行内镜粘膜下剥离术或挖除术治疗的33例上消化道病变的病例资料。结果本组33例患者包括食管病变8例(其中1例合并有食管胃结合部病变),食管胃结合部病变3例(其中1例合并有胃底病变),胃病变19例(其中2例病变多发),十二指肠病变3例。术后病理分别为炎性或增生性息肉11例,腺瘤样息肉3例,囊肿1例,异位胰腺1例,平滑肌瘤2例,间质瘤7例,轻到重度非典型增生7例,早期癌1例。病灶直径0.5～3.5cm。所有患者均顺利完成了内镜下切除手术(1例穿孔较大者联合腹腔镜下修补),手术时间20～120(中位数45)min,出血量2～50(中位数5)ml。其中术中穿孔2例,术中出血2例,术后迟发性出血2例(通过保守治疗痊愈)。33例患者均接受了随访,随访时间2～12个月,无复发或转移病例。结论内镜粘膜下剥离术(ESD)或挖除术治疗上消化道息肉、癌前病变、早期癌及间质瘤的疗效确切,创伤小,恢复快,但有一定的并发症,需由有经验的内镜医生开展。

Objective To evaluate the curative effect of endoscopic submucosal dissection （ESD） or evidement in the therapy of lesions of upper digestive tract. Methods Clinical datas were collected in 33 patients with lesions of upper diges- tive tract who underwent ESD or evidement in our hospital from Jan 2012 to Mar 2013. Results Of the 33 patients, including 8 cases of esophageal lesions （one with gastroesophageal junction lesions meanwhile）, 3 cases of gastroesophageal junction le- sions（one with fundus gastricus lesions meanwhile）, 19 eases of gastropathy（two of them with more than one lesions）,3 cases of duodenum lesions. There were 11 cases of inflammatory or hyperplastic polyps, 3 cases of adenomatous polyps, 1 case of cysts, 1 case of eetopic pancreas, 2 cases of leiomyoma, 7 cases of stromal tumors, 7 cases of mild to severe atypical hyperplasia and 1 case of early cancer. Lesion diameter was 0.5~3.5cm. All patients successfully received endoscopic resection （one case with large perforation received laparoseopic repair）. The operation time was 20-120 （median 45） minutes, the blood loss was 2~50 （median 5）ml. There were 2 cases intraoperative perforation, intraoperative blood loss in 2 cases, and 2 cases of delayed bleed- ing （conservative treatment cured）. 33 patients received follow-up of 2-12 months, no case with recurrence or metastasis. Conclusion ESD or evidement in the treatment of upper digestive tract polyps, precancerous lesions, early carcinoma and stromal tumors was painless, faster recovery. It requires expert endoscope doctor to reduce complication rates.