内镜下黏膜切除术及内镜黏膜下剥离术治疗上消化道早期癌及癌前病变  

Application of endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of the early cancer and precancerous lesion of the upper gastrointestinal tract

作　　者：徐国良[1] 罗广裕[1] 林世永[1] 高晓燕[1] 李茵[1] 单宏波[1] 张蓉[1] 黎建军[1] 贺龙君[1] 王国宝[1] 

机构地区：[1]华南肿瘤学国家重点实验室(中山大学肿瘤防治中心内镜激光科),广东广州510060

出　　处：《中国内镜杂志》2010年第10期1013-1016,共4页China Journal of Endoscopy

基　　金：广州市科委重点课题基金项目(303041106001)

摘　　要：目的评价内镜下黏膜切除术、内镜黏膜下剥离术在上消化道早期癌和癌前病变治疗中的应用价值。方法从2003年5月～2009年12月门诊工作中发现的上消化道早期癌和癌前病变的病例及外院转入的此类病例中,选择符合内镜下治疗的适应证者70例,在全身麻醉(非气管插管)下行内镜下黏膜切除术或内镜黏膜下剥离术。所有病例行内镜下切除术前均行超声内镜检查进一步明确肿物局限于黏膜层,并且无淋巴结转移。术中及术后严密观察相关并发症的发生情况并及时进行处理。结果共完成内镜下黏膜切除术49例、内镜黏膜下剥离术20例。发生术中出血2例,出血量均少于100mL,经保守治疗成功止血;发生术中食管穿孔1例,转外科行手术治疗;未发现术后出血及术后穿孔病例。随访3个月～4年未发现局部复发及食管狭窄病例。结论内镜下黏膜切除术及内镜黏膜下剥离术是治疗上消化道早期癌及癌前病变的有效方法,且安全性好,值得临床推广应用。【Objective】To evaluate the application of endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of the early cancer and precancerous lesion of the upper gastrointestinal tract.【Methods】 Seventy cases were chosen out of the outpatients to receive endoscopic mucosal resection or endoscopic submucosal dissection under general anesthesia. Before endoscopic resection, all cases underwent endoscopic ultrasonography to confirm the depth of tumor invasion and negative lymph node metastases. Complications were treated in time and recorded in detail.【Results】Forty-nine cases of endoscopic mucosal resection and twenty cases of endoscopic submucosal dissection were performed. Two cases of bleeding during the resection occurred, which were successfully managed by expectant treatment. One case of esophageal perforation happened during the performance, which was transferred to surgery. No case of bleeding,perforation, local recurrence or stenosis was observed after resection during the follow up.【Conclusion】Endoscopic mucosal resection and endoscopic submucosal dissection were safe and effective choices for the treatment of the early cancer and precancerous lesion of the upper gastrointestinal tract.

关 键 词：上消化道 早期癌 癌前病变 内镜下黏膜切除术 内镜黏膜下剥离术 

分 类 号：R735.11[医药卫生—肿瘤] R735.2[医药卫生—临床医学]