内镜黏膜下剥离术治疗消化道良性肿瘤30例临床分析

目的：探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）在治疗消化道良性肿瘤中的应用价值。方法收集近2年电子胃肠镜发现的30例胃与大肠黏膜及黏膜下良性肿瘤，内镜超声检查和（或）病理活检进一步明确病灶大小、位置及性质。 ESD操作步骤：黏膜下注射液体以抬高病灶，接着预切开病灶周围黏膜，之后使用Hook刀或IT刀沿病灶黏膜下层完整剥离病灶。结果30例患者均顺利完成ESD治疗，病变直径1.0-3.5cm，平均2.3cm，ESD手术时间30-175min，平均73 min，ESD治疗过程中创面均有少量出血，均经电凝或金属钛夹止血，无术后延迟出血发生，穿孔发生率为6.7%（1/15），术后随访1-8个月，未见肿瘤残留或复发。结论 ESD作为一种内镜微创治疗，能实现较大病灶的完全剥离，为临床提供完整的病理学资料，也为消化道黏膜及黏膜下良性肿瘤的治疗开辟了新的治疗途径。

Endoscopic submucosal dissection in the treatment of gastrointestinal benign tumors clinical analysis of 30 cases

Objective To assess the clinical effects of endoscopic submucosal dissection （ESD） for gastrointestinal benign tu-mors. Methods 30 patients with gastrointestinal mucosal or submucosal benign tumors were enrolled,endoscopic ultrasonography and/or biopsy were applied to confirm the size,location and nature of lesions,the procedures of ESD was as follows;normal saline was injected into the submucosa to elevate the lesion,and the mucosa around the lesion were pre-cut,then dissecting the submu-cosal tissue and resecting the lesion completely with a hook knife or IT knife. Results ESD were successfully performed in 30 pa-tients,the lesions size ranged form 1.0 to 3.5cm （mean 2.3cm） and the operation time was 30 to 175min （mean 73min）,mild bleed-ing occurred in all cases,which was stoped by electric coagulation or endoclip,no delayed bleeding occurred,the perforation rate of ESD was 6.7%（1/15）,the patients were followed up for 1 to 8 months,no tumor residue or recurrence was observed. Conclusion ESD is a novel endoscopic procedure to resect gastrointestinal mucosal or submucosal benign tumors ,which makes it possible to resect whole large lesion and provide precise pathological information.