胃镜下黏膜切除术治疗胃、食管早期癌和癌前病变  

Application of endoscopic mucosal resection to treat early GI cancer and precancerous lesion

作　　者：欧希龙[1] 孙为豪[2] 曹大中[1] 俞谦[1] 俞婷[1] 张有珍[1] 吴自英[1] 刘顺英[1] 

机构地区：[1]东南大学附属中大医院消化科,江苏南京210008 [2]南京医科大学附属第一医院老年医学科,江苏南京210009

出　　处：《中国内镜杂志》2008年第5期461-464,共4页China Journal of Endoscopy

摘　　要：目的分析探讨胃镜黏膜切除术(endoscopic mucosa Iresection,EMR)在治疗胃、食管肿瘤中的临床应用价值。方法回顾对2001年4月～2006年5月胃镜下行EMR治疗的20例25个病变的临床资料。结果25个病灶,直接用圈套器切除19个,用透明帽切除6个。病灶大小为0.6cm×0.6cm～3.0cm×3.5cm,均为扁平病灶,22个病灶1次切除,2个病灶2次分割切除,1个病灶3次分割切除,均取到病理组织,2个未能完全切除,完全切除23个,完全切除率92.0%。隆起型(Ⅰ型)6个,其中亚蒂型(Ⅰsp)1个,无蒂型(Ⅰs)5个;平坦型(Ⅱ型)19个,其中平坦隆起型(Ⅱa)14个,平坦隆起+平坦凹陷型(Ⅱa+Ⅰic)3个,表面平坦型(Ⅱb)2个。癌2个,重度不典型增生4个,中度不典型增生9个,单纯腺瘤6个,非腺瘤性息肉4个。术前病理与术后病理对照相符者16例,占64.0%,不相符者占36.0%。未发生大出血或穿孔等严重并发症,有2次切除后出现少量渗血。结论内镜下黏膜切除术简单、安全。[Objeefive] To discuss the clinical value of endoscopic mucosal resection （EMR） on early gastroesophageal cancer and precancerous lesion. [Methods] Data of 25 lesions in 20 patients treated by EMR were studied, lesions were confirmed histologically before and after operation. [Results] Twenty five lesions from 16 patients were removed by EMR. 19 EMR procedures were performed by snare resection techniques and 6 EMR by using suction cap assisted. Complete resection was achieved in 23. The sizes of lesions were from 0.6 cm×0.6 cm to 3.0 cm×3.5 cm. Lesion type in endoscopy was as follows：6 type Ⅰ lesions （1 type Ⅰ sp lesion, 5type Ⅰ s lesions）, 19 type Ⅱ lesions （14 type Ⅱ a lesions, 3 type V a＋ Ⅱc lesions, 2 type Ⅱ b lesions）. Post-EMR histopathologic evaluation revealed the following： 2 carcinoma lesions, 4 HGD lesions, 9 MGD lesions, 6 adenoma lesions, 4 non-adenomatous polyp lesions. The early cancer of EMR samples and that of routine biopsy samples were 2 （2/25） and 0 respectively. The detection rate of cancer, HGD and MGD by EMR was higher than that by routine operation. No serious complications were recorded. There was no perforation case. Errhysis occured after resection of 2（2/21） lesions. All of them were cured, [Conclusion] Endoscopic mucosal resection has significant value in the endoscopic intervetion treatment for early cancer and precancerous lesion in GI. EMR technique is safe and effective.

关 键 词：胃镜 黏膜切除术 早期癌 癌前病变 

分 类 号：R573[医药卫生—消化系统]