内镜黏膜下剥离术治疗食管肿瘤的临床价值  

Clinical value of endoscopic submucosal dissection for esophageal tumors

作　　者：彭贵勇[1] 武育卫[1] 龙庆林[1] 陈磊[1] 赵京晶[1] 周倩[1] 

机构地区：[1]第三军医大学西南医院全军消化病研究所,重庆400038

出　　处：《第三军医大学学报》2009年第16期1527-1529,共3页Journal of Third Military Medical University

基　　金：重庆市科技攻关项目(2008AC5003)~~

摘　　要：目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在食管肿瘤治疗中的价值。方法利用染色内镜及超声内镜探测病变范围及侵犯深度,对位于黏膜层及黏膜肌层的早期癌、癌前病变、黏膜下肿瘤等病变行ESD治疗。于病灶边缘2mm处用氩气刀标记切除范围,于病灶及周围黏膜下注射甘油果糖使病变与固有肌层相分离;沿标记线外侧切开病变周围黏膜;剥离病变下方黏膜下层组织,完整切除病变。结果21例病灶,最大直径均大于2cm,病灶最大者直径5cm。8例早期食管黏膜内癌,5例食管黏膜中、重度异型增生及8例食管平滑肌瘤经ESD一次性完全切除。ESD手术时间30～180min,平均110min;术中少量出血均经电凝止血;术后无迟发性出血发生;1例早期食管癌术中发生穿孔(4.76%),经内镜金属夹封闭、内科保守治疗后痊愈。术后随访1～12个月无复发。结论在超声内镜及色素内镜的指导下,采用内镜黏膜下剥离术治疗食管黏膜内癌、癌前病变及黏膜肌层的肿瘤,是一项安全有效的内镜治疗方法。Objective To investigate the value of endoscopic submucosal dissection （ESD） in treatment of esophageal tumors. Methods The properties, range and infiltrating depth of the neoplastic lesions in esophagus were detected by chromoendoscopy and endoscopic ultrasonography. The mucosal lesions including early cancers, submucosal tumors deriving from mucosa were removed by ESD： injecting fructose-glycerol fluid into the submucosa to elevate the lesion from the muscle layer, pre-cutting the surrounding mucosa of the lesion, and dissecting the connective tissue of the submucosa beneath the lesion. Results The diameter in all 21 lesions was larger than 2 cm, and the largest was as large as 5 cm. All the lesions, including 8 cases of early esophageal cancer, 5 cases of esophageal mucosa moderate and severe dysplasia, and 8 cases of esophageal leiomyoma, were removed by ESD radically. The time for ESD operation was 30 - 180 minutes （ average time ： 110 minutes ）. A small amount of intraoperative bleeding was stopped by eleetrocoagulation hemostasis. No delayed postoperative bleeding occurred. Perforation occurred in one patient of early esophageal cancer （4.76%） , but was cured by endoscopic metal clip closure and medical conservative treatment. No recurrence was found during the follow-up for 1 - 12 months. Conclusion With the aid of chromoendoscopy and endoscopic uhrasonography, endoscopic submucosal dissection is a safe and effective endoscopic treatment method for esophageal mueosal cancers, precancerous lesions and subrnueosal tumors.

关 键 词：食管 早期癌 黏膜下肿瘤 内镜黏膜下剥离术 

分 类 号：R730.56[医药卫生—肿瘤] R735.1[医药卫生—临床医学]