内镜粘膜切除术的临床应用附92例分析

Clinical application on endoscopic mucosal resection:analysis of 92 cases

目的 评价内镜粘膜切除术治疗消化道浅表肿瘤病变的效果 ,并对其适应症、并发症和操作方法等问题进行讨论。方法 选择符合内镜粘膜切除术适应症的 92例患者 ,应用辅助吸引帽切除术和 /或注射高渗肾上腺素盐水圈套切除术 ,切除了1 0 1处病变。对手术发生的并发症进行观察和处理 ,以及手术前后病理诊断进行对照研究 ,并随访了部分患者的无癌生存率。结果 92例患者 ,EMR切除病变 1 0 1处 ,完全切除率达 89%。术后病理诊断腺癌 1 6例 ,类癌 3例 ,重度异型增生 1 3例 ,低度异型增生 3例 ,腺瘤 4 7例 ,其他良性病变 1 9例。并发症主要是出血 ,2 2例占 2 1 .8% ,均经处理而痊愈 ,无 1例发生穿孔等严重并发症。腺癌完全切除患者无癌生存时间平均 2 7个月。结论 内镜粘膜切除术是治疗早期胃肠道癌和癌前病变的微创介入治疗方法 ,对大多数患者能达到完全切除 ,其效果好、易操作、较安全 。

Objective To evaluate the efficacy of endoscopic mucosal resection (EMR) for treating the superficical neoplastic lesions of the GI tract and to discuss its indication,complication and procedure.Methods One hundred one lesions were removed by endoscopic mucosal resection from 92 cases patients who eligible for mmucosectomy.EMR procedures performed by using suction cap assisted and /or saline solution assisted snare resection techniques.Some complications which occurred during endocopic therapy were observed and treated.Hiscopathologic results were compared for Pre EMR and post EMR,and survival rate was assessed in some patients. Results one hundred one lesions were removed from 92 patients.Complete resection(CR) was achieved in 89%,post EMR histopathologic evaluation revealed the following:carcinoma 16 cases,carcinoid 3 cases,HGD 13 cases,LGD 3 cases,adenoma 47 cases,benign lesion 19 cases.The complications bleeding occured in 22(21.8%)patients.All of them were cured.There was no perforation case.The patients with adenocarcinoma had CR by EMR,the median cancer free survival was 27 months.Conclusion Endoscopic mucosal resection has siginifiant value in the endoscopic intervetion treatment for early cancer in GI.The CR was achieved in the majority of cases and EMR technique are safe and effctive.