内镜黏膜下剥离术治疗食管早期癌及癌前病变  

Endoscopic submucosal dissection for early esophageal carcinomas and pre-malignant lesions

作　　者：周平红[1] 姚礼庆[1] 马丽黎[1] 陈巍峰[1] 徐关东[1] 钟芸诗[1] 张轶群[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内镜诊疗研究所,上海200032

出　　处：《中华消化内镜杂志》2008年第11期570-573,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜黏膜下剥离术（ESD）治疗食管早期癌及癌前病变的应用价值。方法对胃镜发现的食管早癌和上皮内瘤变、深度未超越黏膜下层者15例进行ESD治疗：（1）黏膜下注射生理盐水抬高病变；（2）预切开病变周围黏膜；（3）沿病变下方黏膜下层完整剥离病变。结果15例食管早癌和上皮内瘤变病变，最大直径2．5～4．5cm（平均3．2cm）。14例病变成功完成ESD治疗，ESD成功率93．3％（14／15）。所有剥离病变全部得到病理确诊，基底和切缘未见病变累及。ESD手术时间（自黏膜下注射至完整剥离病变）45～150min，（平均75min）。术中出血量平均30ml，均经电凝、氩离子凝固术和止血夹成功止血，未出现需再次内镜下治疗的出血；ESD穿孔发生率0（0／15）。术后随访14例，随访期6～18个月（平均11．5个月），创面完全愈合，无一例病变残留和复发。结论ESD是治疗食管早癌和癌前病变的新方法，不仅能完整切除较大的病变，还能提供完整的病理学诊断资料。Objective To assess the clinical application of endoscopic submueosal dissection（ESD） for early esophageal carcinomas and pre-malignant lesions. Methods ESD was performed for early esophageal carcinomas and intraepithelial neoplasms without submucosal infiltration. First, normal saline was injected into the submucosa to elevate the lesion from the muscle layer. Then, the surrounding mucosa of the lesion were cut, and the lesion was dissected along the connective tissue of the submucosa. Results Of 15 early esophageal carcinomas and intraepithelial neoplasms, ranging from 2.5 to 4. 5 cm （ mean size 3.2 cm） , 14 （93. 3% ） underwent ESD successfully . All 14 lesions were confirmed pathologically, and no basal or dissected margin was involved. The mean ESD procedure time （from fluid injection to complete dissection） was 75 min （ranging from 45 to 150 min）. Minor bleeding （mean volume 30 ml） occurred in all lesions, which was stopped by electric coagulation, argon plasma coagulation and clamps. No delayed bleeding occurred. The perforation rate of ESD was 0（0/15）. Fourteen patients were followed up after ESD for 6 to 18 months （mean = 11.5 ） , and healed with no residue or recurrence. Conclusion ESD is a novel endoscopic procedure to resect early esophageal carcinomas and pre-malignant lesions, with which large lesions can be resected and pathological information can be provided.

关 键 词：食管肿瘤 内窥镜检查 胃肠道 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]