内镜黏膜下剥离术治疗胃黏膜浅表病变的疗效和并发症分析

Endoscopic submucosal dissection in treatment of superficial lesions of gastric mucosa:analysis of efficacy and complications

目的探讨内镜黏膜下剥离术(ESD)治疗胃黏膜浅表病变的临床安全性和效果,并对ESD治疗出现并发症的相关因素及处理进行分析。方法回顾性分析116例胃黏膜浅表病变行ESD治疗患者的临床病例资料,观察ESD的治疗情况和效果,分析术中及术后出现并发症的相关因素及处理情况。结果 116例胃黏膜浅表病变全部完成ESD治疗,一次性整块切除率为99.1%(115/116),组织学完全治愈性切除率为95.7%(111/116),肿瘤平均最大径为(25.0±11.6)mm,平均手术时间(56.6±20.5)min;术中急性少量出血发生率为3.4%(4/116),无急性大量出血发生,延迟性出血发生率为0.9%(1/116);5例出血病例均应用电凝止血和止血夹联合内镜下止血成功;术中穿孔发生率为2.6%(3/116),3例穿孔病例在术中应用钛夹夹闭,穿孔患者无气腹发生,均保守治疗成功。ESD术后2个月时复查,创面溃疡愈合率为100%,术后平均随访(20.3±5.1)个月。术中出血和穿孔发生的危险因素为胃角(χ~2=7.937,P=0.01)及术后病理结果为早期胃癌(χ~2=9.145,P=0.005)。结论 ESD是一种安全有效的胃黏膜浅表病变微创治疗方法,手术操作成功率高;强调ESD术中和术后应注意预防性止血。强调早期术中发现穿孔,大多能完成内镜下穿孔的有效闭合。

ObjectiveTo investigate the clinical safety and efficacy of endoscopic submucosal dissection(ESD)in the treatment of superficial lesions of gastric mucosa,and to analyze the related factors and management of complications of ESD treatment.MethodsWe retrospectively analyzed the clinical data of116patients with superficial lesions of gastric mucosa undergoing ESD,evaluated the efficacy of ESD,observed the appearance and treatment of complications of ESD,and analyzed the factors influencing intraoperative and postoperative complications.ResultsThe ESD was successfully completed in all cases,with the en bloc resection rate being99.1%(115/116)and the complete cure rate being95.7%(111/116).The average tumor size was(25.0±11.6)mm,and the average operation time was(56.6±20.5)min.The incidence rates of acute slight bleeding during operation and delayed bleeding were3.4%(4/116)and0.9%(1/116),respectively,without acute hemorrhage;5cases of bleeding were successfully treated by coagulation hemostasis and hemoclip.Perforation occured in3cases(2.6%)and was closed by hemoclip during operation;all cases of perforation had no pneumoperitoneum and were treated successfully by conservative method.Review at2months after ESD showed that the ulcer healing rate was100%.The average follow up time was(20.3±5.1)months.Gastric angle(χ2=7.937,P=0.01)and the postoperative pathological results as early carcinoma(χ2=9.145,P=0.005)were risk factors influencing the intraoperative bleeding and perforation complications.ConclusionESD is a safe and effective minimally invasive treatment,and has high operation success rate.The prevention of bleeding should be emphasized during and after ESD operation.Perforation complications also should be discovered during the early stage of operation,which can contribute to complete effective closure of perforation under endoscope in most cases.