内镜黏膜下剥离术治疗胃食管结合部息肉样隆起性病变的临床价值

Therapeutic value of endoscopic submucosal dissection for polypus protrusion lesion on esophagogastric junction

目的评价胃食管结合部（EGJ）息肉样隆起性病变行内镜黏膜下剥离术（ESD）治疗的疗效与安全性。方法对111例（114处病变）ESD治疗的EGJ息肉样隆起性病变病例进行回顾性分析，主要观察指标包括ESD切除率、手术时间、并发症和复发情况。结果病变大小1.0-6.0 cm，平均（2.47±0.80）cm。表面光滑30处，充血糜烂59处，结节样粗糙11处，分叶状3处，绒毛状8处，浅溃疡1处，局部凹陷2处；术后病理提示上皮内瘤变19处、腺癌2处，瘤变及癌变率为18.42%（21/114）。ESD治疗整块切除率为100.0%（114/114），完整切除率为99.1%（113/114），完整治愈切除率为97.4%（111/114）。操作时间17.0-60.0 min，平均为（32.45±7.32）min。3例发生术后迟发性出血、1例发生术中穿孔，均在内镜下治疗成功。术后2例追加手术治疗。随访96例，平均随访28.8个月，有1例（1.04%，1/96）复发。结论EGJ息肉样隆起性病变的上皮内瘤变及癌变发生率较高，采用ESD治疗整块切除病变，完整治愈切除率高、并发症少、复发率低。

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） in the treatment of patients with polypus protrusion lesion on esophagogastric junction（EGJ）.MethodsA retrospective analysis was made on the data of 111 cases （114 lesions） with EGJ polypus protrusion undergoing ESD. The main observation indicators included ESD resection rate, operation time, complication, and recurrence.ResultsThe diameter of the 114 lesions was 1.0-6.0 cm （mean 2.47±0.80 cm）. Among the lesions, 30 had smooth surface, 59 had congestion anabrosis, 11 had nodular rough, 3 were lobulated, 8 had villiform, 1 had slight anabrosis, and 2 had local dent. The postoperative pathology analysis showed 19 lesions were intraepithelial neoplasia and 2 were adenocarcinoma. The rate of neoplasia and cancerization was 18.42% （21/114）. The monolithic resection rate of ESD was 100.0% （114/114）, complete resection rate was 99.1% （113/114）, complete healing resection rate was 97.4% （111/114）. The mean operation time was 32.45±7.32 min （17.0-60.0 min）. Tardive bleeding after operation occurred in 3 cases, perforation in operation occurred in 1 case, and all the 4 cases were successfully treated by endoscopy. After operation, 2 cases underwent additional surgical procedures. A total of 96 cases were followed-up, with average follow-up time of 28.8 months, and 1 patient （1.04%, 1/96） relapsed.ConclusionThe intraepithelial neoplasia and cancerization rate caused by polypus protrusion lesion on EGJ is generally higher than prediction. ESD can monolithic resect lesions with higher complete healing resection rate, fewer complications, and lower recurrence rate.