内镜黏膜下剥离术在治疗胃肠道黏膜切除术后残留和复发病灶中的应用  

Endoscopic submucosal dissection for local residual and recurrent lesions in digestive tract after endoscopic mucosal resection

作　　者：周平红[1] 姚礼庆[1] 陈巍峰[1] 徐美东[1] 钟芸诗[1] 张轶群[1] 马丽黎[1] 秦文政[1] 秦新裕[1] 

机构地区：[1]复旦大学附属中山医院内镜中心复旦大学上海医学院外科学系,上海200032

出　　处：《中华消化内镜杂志》2008年第6期281-285,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜黏膜下剥离术（ESD）治疗胃肠道黏膜切除术（EMR）后残留、复发病变的疗效和安全性。方法自2006年6月至2007年11月对EMR术后内镜随访发现的15例残留和复发病变进行ESD治疗，先于黏膜下注射生理盐水以抬高病变，接着预切开病变周围黏膜，再沿病变下方黏膜下层进行剥离，对瘢痕形成部位直接应用Hook刀沿瘢痕基底切线方向进行切开。结果15例EMR术后残留和复发病变，位于胃6例、结肠3例、直肠6例，病变直径0．8～3．5em，平均2．3em。所有病变抬举征（-）。14例病变成功完成ESD治疗，成功率93．3％（14／15），13例术后病理切缘和基底无肿瘤累及，完整切除率86．7％（13／15）。ESD手术时间60～155min，平均87min。治疗中创面均有少量出血，全组未出现术后出血。2例治疗中局部剥离较深、腹腔出现游离气体，成功保守治疗，未转外科手术，ESD穿孔发生率13．3％（2／15）。术后平均随访13个月，无复发。结论ESD治疗EMR术后残留和复发病变相对安全、有效，不仅能完整切除残留和复发病变，还能提供完整的病理诊断资料。Objective To determine the efficacy and safety of endoscopic submucosal dissection （ESD） for local residual and recurrent lesions in digestive tract after endoscopic mueosal resection （EMR）. Methods From June 2006 to November 2007, 15 patients with local residual and recurrent lesions of digestive tract after EMR underwent ESD. The procedures of ESD were as follows ： normal saline was injected into the sub- mueosa to elevate the lesions from the muscle layer, and the mueosa around the lesions were pre-eut, then the connective tissue of the submueosa beneath the lesions was dissected, and the sear beneath the lesion was re- seeted along the plane of the submueosa with a Hook-knife. Results The mean diameter of 15 residual and re- current lesions after EMR were 2. 3 era（0. 8 - 3. 5 era）, of which 6 lesions were located in stomach, 3 in colon and 6 in rectum. All eases showed negative lifting sign due to sear formation. Fourteen lesions were completely re- sected and the overall resection rate was 93. 3% （14/15）. It was pathologically confirmed that 13 cases showed no tumor involvement in lateral and basal resection margins, and the complete resection rate was 86. 7% （13/15）. The mean operation time was 87 min（ranging from 60 to 155 min）. Minor bleeding occurred during ESD in all ca- ses, but there was no postoperative bleeding. Two eases had free air in abdominal cavity due to deep dissection, but recovered with conservative treatment after ESD without surgical involvement. The perforation rate was 13. 3% （2/15）. The mean follow-up period was 13 months and no recurrence was recorded. Conclusion ESD proves to be a novel, safe and effective procedure for local residual and recurrent lesions after previous EMR, which makes it possible to reseet the lesions completely and provide precise pathological information.

关 键 词：消化道 残留 复发 内镜黏膜切除术 内镜黏膜下剥离术 

分 类 号：R656[医药卫生—外科学] R73[医药卫生—临床医学]