内镜黏膜下剥离术治疗消化道病变的效果评价

目的 探讨内镜黏膜下剥离术（ESD）对消化道病变的治疗效果和手术并发症情况.方法 选择45例病人的消化道黏膜层或黏膜下层病变进行ESD治疗,术前行染色内镜或超声内镜检查确定病变范围和深度.记录手术时间、完整切除率、出血情况和消化道穿孔发生情况,术后随访创面愈合和病变复发情况.结果 接受ESD的病例中有上消化道病变36例,下消化道病变9例.病变直径1～5 cm,平均2.7 cm.手术时间30～90 min,平均50 min.完整切除率为97.8％.治疗过程中创面少量出血予电凝处理,未出现术后迟发性出血.出现穿孔1例,经保守治疗痊愈.术后随访39例病人,平均随访期21个月,所见创面愈合,无病变残留和复发,未见消化道狭窄的发生.结论 ESD是一种治疗消化道癌前病变、早期癌灶和黏膜下病变的有效、微创的方法.

THE EFFECT OF ENDOSCOPIC SUBMUCOSAL DISSECTION （ESD） ON THE TREATMENT OF GASTROINTESTINAL LESIONS

Objective To explore the effect of endoscopic submucosal dissection （ESD） on the treatment of gastrointestinal lesions and the operative complications. Methods Forty-five patients with mucosal or submucosal lesions were treated with ESD. Endoscopic examinations with staining or ultrasound were used to define the scope and depth of the lesions before the operation. The operation time, complete resection rate, bleeding volume and gaslrointestinal perforation rates were observed. The postoperative conditions of wound healing and recurrences were examined. Results Thirty-six lesions were in upper gastrointestinal tract and nine were in lower tract. The diameter of lesion was 1-5 cm,with an average of 2.7 cm. The op- eration time was 30-90 minutes, with an average of 50 minutes. The complete resection rate was 97.8%. A small amount of bleeding in raw surface during the ESD process was treated with electric coagulation. No delayed hemorrhage occurred after the operation. One case of perforation occurred during the operation and was treated well with expectant treatment. Thirty-nine cases were followed up during an average duration of 21 months. All the wounds healed well without any residual, recurrence or gastrointestinal stricture. Conclusion ESD is an effective and mini-invasive therapy for patients with precancerous lesions, early cancer and submucosal lesions of gastrointestinal tract.