内镜黏膜下剥离术诊治消化道病变的临床研究

目的探讨内镜黏膜下剥离术(ESD)诊治消化道黏膜及黏膜下病变的疗效和安全性。方法应用内镜黏膜下剥离术诊治消化道病变68例,对病例的大块切除率、病理符合率、并发症发生率、复发率等进行评估。结果 68例患者切除病灶共69处,40处(58.0%)完整大块切除,64处(92.8%)在内镜下完全切除。23例术前曾行病理活检,13例(56.5%)术前病理与术后病理吻合,10例(43.5%)切除后大体标本送检明确病变性质。发生术后出血3例(4.4%);术中穿孔1例(1.5%),立即钛夹封闭后接受外科手术治疗。平均随访5.7个月,随访率34.8%(23/66),1例直肠腺瘤在随访的第14个月复发。结论 ESD是治疗消化道病变的一项有效的内镜微创技术,可完整大块切除较大的病灶,提高病变确诊率,而术后钛夹夹闭创面未能明显降低术后出血的发生率。

Clinical study on endoscopic submucosal dissection in the treatment of gastrointestinal mucosal and submucosal lesions

Objective To evaluate the effectiveness and safety of endoscopic submucosal dissection（ESD） in the diagnosis and therapy of gastrointestinal mucosal and submucosal lesions. Methods Sixty-eight cases of gastrointestinal mucosal and submucosal lesions were diagnosed and treated by ESD. The en block resection rate,complication rate, and recurrence rate of the group were evaluated. Results Sixty eight patients with 69 lesions underwent ESD successfully, among which, 40（58.0%） lesions were en bloc resection, and 64（92.8%） lesions were removed completely. Twenty-three cases had histological biopsy before the operation, among which, 13 showed consistent diagnosis before and after the procedure （56.5%）, and 10 cases （43.5%） had a clear diagnosis relying on larger biopsy after the procedure. There were 3 cases （4.4%） of post-ESD bleeding and one case （1.5%） of perforation during the procedure of ESD, which were performed with tanium clipping and then laparotomy successfully. Median follow-up period was 5.7 （range, 1-23.5） months with a rate of 34.8%（23/66）. There was a recurrence case of rectal adenoma in the 14th month of follow-up with a rate of 1.5%. Conclusions ESD is an effective and minimal invasive endoscopic technique in removing gastrointestinal lesions. It allows en-bloc removal of large lesion and is associated with a higher diagnostic rate. Titanium clips of the trauma fail to reduce the post-ESD bleeding rate.