消化道早期癌和癌前病变采用内镜黏膜下剥离术治疗的效果

Clinical effect of endoscopic submucosal dissection on early gastrointestinal cancer and precancerous lesions

目的研究内镜黏膜下剥离术治疗消化道早期癌和癌前病变的效果。方法选取我院2016年7月至2017年2月收治的消化道早期癌和癌前病变患者50例,所有患者均给予内镜下黏膜剥离术治疗。观察记录患者的治疗效果、并发症发生情况和病理结果。结果病灶位置在食管处13例,胃部24例,结肠13例;手术用时(56.2±5.6)min;住院时间为(10.2±1.2)d;完整切除46例,治愈性切除45例;术中出血2例,出血量分别为200 m L和235 m L;迟发性出血1例;3例患者发生穿孔;1例黏膜下低分化腺癌,10例黏膜内癌,4例黏膜下层浅层癌,25例高级别上皮内瘤变,10例为低级别上皮内瘤变。结论内镜黏膜下剥离术治疗消化道早期癌和癌前病变的效果显著,整块切除率高、术后并发症发生率低,值得临床推广应用。

Objective To study the clinical effect of endoscopic submucosal dissection on early gastrointestinal cancer and precancerous lesions. Methods Fifty patients with early gastrointestinal cancer and precancerous lesions admitted in our hospital from July 2016 to February 2017 were selected, and all the patients were given endoscopic mucosal dissection treatment. The treatment effect, incidence of complications and pathologic analysis were observed and recorded. Results There were 13 cases with focus on esophagus, 24 cases on stomach and 13 cases on colon. The time of operation and hospitalization were（56.2±5.6） min and（10.2±1.2） d respectively. There were 46 cases with bloc resection and 45 cases with curative resection. There were 2 cases with intraoperative hemorrhage and the bleeding loss were 200 m L and 235 m L respectively. There were 1 cases with late-onset bleeding and 3 cases with perforation. There were 1 case with submucosal poorly differentiated adenocarcinoma, 10 cases with mucosal carcinoma, 4 case with submucosal carcinoma, 25 cases with high-grade intraepithelial neoplasia and 10 cases with low-grade intraepithelial neoplasia change. Conclusion Endoscopic submucosal dissection for early gastrointestinal cancer and precancerous lesions has good therapeutic efficacy,with high bloc resection rate and low incidence of postoperative complications, which is worthy of promotion and application in clinic.