内镜黏膜下剥离术治疗上消化道病变的疗效分析:附30例报告

Efficacy Analysis of Endoscopic Submucosal Dissection for the Treatment of Upper Gastrointestinal Lesions:a Report of 30 Cases

目的：探讨采用内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗上消化道病变的疗效和安全性。方法：应用IT刀、HOOK刀通过ESD治疗经胃镜检查发现的上消化道黏膜及黏膜下病变30例。具体过程为：（1）黏膜下注射0.9%氯化钠液抬高病变处黏膜层;（2）预切开病变周围黏膜;（3）充分剥离病变周围结缔组织,完整剥离病变。结果：病变直径为0.8~4.5 cm,平均（2.6±1.3）cm。术后病理证实,2例经ESD剥离病变后创面仍有肿瘤残留,行外科手术扩大切除;其余28例病变全部完整剥离,完整剥离病变的成功率为93.3%（28/30）。ESD手术时间（自黏膜下注射至完整剥离病变）为29~110 min,平均（48±11.2）min。平均术中出血量约为45 mL,出血均经电凝、氩离子血浆凝固术成功止血;1例（术前停用阿司匹林5 d）术中创面出现少量渗血,术后给予保守治疗后成功止血,ESD出血发生率为3.33%（1/30）。3例在ESD治疗中发现有约1.0cm的穿孔,均应用金属夹成功缝合穿孔,未中转开腹手术;ESD穿孔发生率为10.0%（3/30）。术后16例得到随访,随访时间为3~6个月,平均（4.5±1.2）个月。16例的创面基本愈合,无病变残留和复发。结论：采用ESD治疗上消化道病变的疗效可靠,能完整切除较大的病变并提供完整的病理学诊断资料;患者痛苦小、恢复快、复发率低。

Objective：To investigate the efficacy and safety of endoscopic submucosal dissection（ESD）for the treatment of upper gastrointestinal lesions.Methods：IT knife and HOOK knife were applied in ESD for the treatment of 30 cases of upper gastrointestinal mucosal or submucosal lesions revealed by gastroscopy.The ESD procedure was conducted as follows.Firstly,0.9% sodium chloride solution was injected into the submucosa so as to elevate the mucosa on lesion.Secondly,the mucosa around the lesion was pre-cut.Thirdly,the lesion was dissected completely from the surrounding connective tissue.Results：The diameters of the lesions ranged from0.8 to 4.5 cm with mean of（2.6±1.3）cm.As postoperative pathology confirmed,there was tumor residual on wound surface of 2 cases after ESD,and they received extended resection.And the lesions of the other 28 cases were successfully resected by ESD.The success rate of complete dissection was 93.3%（28/30）.The ESD procedure time（from fluid injection to complete dissection）ranged from29 to 110 min,with a mean of（48±11.2）min.The average amount of bleeding during operation was 45 mL and the bleeding was successfully stopped by electro-coagulation,argon plasma coagulation.One patient（aspirin was stopped 5 days before operation）suffered hemorrhage per-diapedesin and recovered after conservative treatment.The bleeding rate of ESD was 3.33%（1/30）.Perforation occurred in 3 cases during the ESD procedure,and was closed with metallic endoclip.And no case was transferred to laparotomy.The perforation rate of ESD was 10.0%（3/30）.After the operation,16 cases were followed up.And the follow-up period ranged from 3 to 6months,with a mean of（4.5±1.2）months.The wound surfaces of 16 cases were healed,and there was no residue or recurrence.Conclusions：The curative effect of ESD for the treatment of upper gastrointestinal lesions is reliable,as it can not only wholly remove the large lesion,but also provide with pathological proof.With ESD,less pain,faster rehabilitation,and lower recurrent rate can be achieved for patients.