内镜黏膜下剥离术在早期胃癌及胃黏膜上皮内瘤变中的临床应用

Clinical application of endoscopic submucosal dissection in the early stage of gastric cancer and gastric mucosal intraepithelial neoplasia

目的：探讨内镜黏膜下剥离术(ESD)治疗早期胃癌和胃黏膜上皮内瘤变的价值。方法：收治行ESD治疗早期胃癌(EGC)及胃黏膜上皮内瘤变患者192例，评价其临床病例资料及并发症，并随访3～12个月。结果：192例患者完整切除率100%，治愈性切除率98.44%，术后复发率1.10%；手术平均时间87.3min，平均住院日3d，平均住院费用0.67万元；术中未发生大出血事件，延迟出血发生4例，均在胃镜下成功止血。术中发生穿孔3例，以金属夹夹闭后治愈。结论：ESD治疗能够完整切除胃黏膜病变组织，且手术时间短、并发症少、住院时间短，但临床要严格掌握适应证，进一步完善规范化操作。

Objective:To evaluate the value of endoscopic submucosal dissection(ESD)in the treatment of early gastric cancer andgastric mucosal intraepithelial neoplasia.Methods:192 patients with gastric cancer(EGC)and gastric mucosal intraepithelialneoplasia treated by ESD were selected.We evaluated the clinical data and complications,and followed up for 3 to 12 months.Results:The complete resection rate was 100% in 192 patients,and the curative resection rate was 98.44% ;the postoperativerecurrence rate was 1.10% and the average time of operation was 87.3 min.The average length of stay was 3 days,and the averagehospitalization cost was 6 thousand and 700 yuan.No major bleeding events occurred during the operation,and 4 cases of delayedbleeding occurred;all were successfully hemostasis under endoscopy.The intraoperative perforation occurred in 3 cases,thepatients were cured with a metal clip.Conclusion:ESD treatment can complete resection of gastric mucosal lesions,with shorteroperation time,fewer complications,shorter hospital stay.In clinica,we need to strictly grasp the indications to further improve thestandardization of operation.