胃镜黏膜下剥离术治疗胃食管连接部黏膜病变30例临床分析

Endoscopic submucosal dissection in the treatment of mucosal lesions at the gastroesophageal junction

目的探讨胃镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃食管连接部黏膜病变的疗效及安全性。方法回顾性分析30例胃食管连接部黏膜病变患者临床资料,分析病变特点及ESD治疗切除率和手术时间,随访观察术后并发症和复发情况。结果患者胃食管连接部黏膜病变直径(30±15)mm,ESD治疗完整切除率为100%,手术时间(45±16)min;术后1例有少量胃管内出血,未发生穿孔等并发症;组织病理确诊黏膜慢性炎症8例,萎缩性胃炎3例,增生性息肉6例,低级别上皮内瘤变9例,高级别上皮内瘤变3例,腺癌1例;平均随访18个月,无复发。结论 ESD治疗胃食管连接部黏膜病变的完整切除率高,安全。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） in the treatment of mucosal lesions at the gastroesophageal junction （GEJ）. Methods The clinical data of 30 cases of mucosal lesions at the GEJ were analyzed retrospectively the features of lesion, resection rate and operation lasting time. The incidence of complications and recurrence were observed. Results The mean lesion diameter was （30 ± 15） mm. The complete resection rate was 100%. The operation lasted for （45 ± 16） min averagely. After surgery, a small amount of bleeding was found in 1 case, and no perforation occurred. The postoperative histopathological examination confirmed 8 cases of chronic mucosal inflammation, 3 cases of atrophy gastritis, 6 cases of hyperplastic polyps, 9 cases of low-grade intraepithelial neoplasia, 3 cases of high-grade intraepithelial neoplasia, and 1 case of adenocarcinoma. No recurrence was found during 18-month follow-up. Conclusion ESD is a safe and effective surgical method for mucosal lesions at GEJ, with high resection rate.