内镜黏膜下剥离术治疗上消化道黏膜下病变的价值及并发症危险因素

Clinical effects of endoscopic submucosal dissection in treatment of upper gastrointestinal submucosal tumors

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在上消化道黏膜下肿瘤(submucosal tumor,SMT)中的治疗价值及并发症危险因素.方法:回顾性分析2009-05/2014-03于成都军区总医院实施ESD治疗的73患者临床资料,主要分析其整块切除率、治愈性切除率、复发率、并发症发生率,利用Logistic回归分析并发症的危险因素.结果:73例患者中,成功实施ESD 69例,其中整块切除率为98.6%,治愈性切除率为100%,复发率为0,中位手术时间为100.9min(30.0-275.0 min),出血发生15例,穿孔发生7例,没有死亡病例.结论:ESD可以有效的治疗SMT,但位于贲门-胃底的病变,应注意防治并发症的发生.

AIM：To explore the therapeutic efficiency of endoscopic submucosal dissection（ESD） in the treatment of upper gastrointestinal submucosal tumors and the risk factors for complications.METHODS：Seventy-three patients with uppergastrointestinal submucosal tumors were collected from Chengdu Military Medical Hospital from May 2009 to March 2014.All the patients underwent ESD and were followed by endoscopy.The complete resection rate,the frequency of complications and the risk factors for complications were analyzed.RESULTS：The overall rate of R0 resection was 98.6%（68/69）,with six endoscopic failures.Complete resection was achieved in all submucosal tumor（SMT） cases.The median procedure time was 100.9 min（range,30.0-275.0 min）.Perforation occurred in 7 patients.Bleeding occurred in 15 patients.No death occurred.No recurrence cases were noted.CONCLUSION：ESD is an effective treatment in SMT patients with a high success rate and a low incidence of complications.