内镜下黏膜剥离术治疗上消化道肿瘤性病变  

Endoscopic submucosal dissection for upper gastrointestinal lesions

作　　者：李学良[1] 沙杰[1] 施瑞华[1] 于莲珍[1] 胡小丹[1] 丁静[1] 许迎红[1] 陈莉[1] 陶桂[1] 莫静[1] 张道权[1] 

机构地区：[1]南京医科大学第一附属医院消化科,江苏南京210029

出　　处：《中国内镜杂志》2011年第2期116-120,共5页China Journal of Endoscopy

基　　金：江苏省"六大人才高峰"第五批高层次人才资助项目(卫生行业)

摘　　要：目的探讨内镜下黏膜剥离术(ESD)治疗上消化道肿瘤性病变的应用价值。方法对胃镜检查发现的上消化道黏膜及黏膜下病变患者共78例行ESD治疗。内镜下明确病变边界,采用氩离子凝固术(APC)或针刀在病变周围电凝标记,行黏膜下注射,使病变完全抬起,用钩刀环形切开黏膜至黏膜下层I,T刀逐层分离,直至最终剥离病变组织。结果 78例上消化道病变,其中食管病变27例,黏膜病变5例,黏膜下病变22例;胃病变50例,黏膜病变12例,黏膜下病变38例;十二指肠黏膜下病变1例。病变直径0.4～5.0 cm,平均1.44cm。77例病变成功完成ESD治疗,ESD成功率98.7%(77/78)。78处病灶整块切除率为91.0%(71/78)。ESD手术时间(自病灶染色至完整剥离)20～210 min,(平均58.3 min)。术中程度不等出血,均经电凝、APC和止血夹成功止血,未发生迟发性出血。ESD穿孔发生率3.84%(3/78),2例保守治疗愈合,1例胃底部病例因肿瘤过大(直径约5 cm)术中合并穿孔未能完成治疗送外科手术。52例随访2～17个月均无病变残留或复发。结论 ESD可以一次性完整切除较大的病变,提供完整的病理学诊断资料,是一种治疗上消化道病变的安全有效的方法。【Objective】 To assess the clinical application of endoscopic submucosal dissection（ESD） for upper gastrointestinal lesions.【Methods】 ESD was performed on 78 patients of upper gastrointestinal mucosal and submucosal lesions.First marks were made around the lesion with APC,then solution injected into submucosal to elevate the lesion,and the mucosa and submucosa were cut along the margin with hook knife.The submucosa was carefully dissected until the lesions were completely removed with IT knife.【Results】 Of the 78 upper gastrointestinal lesions,27 was esophageal lesions,five was mucosal lesions,22 was submucosal lesions;50 was gastric lesions,12 was mucosal lesions,38 was submucosal lesions;one was duodenal mucosal lesion,ranging from 0.4 to 5.0 cm（mean size 1.44 cm）,77（98.7%） underwent ESD successfully.The rate for one-piece resection with tumor-free margins was 91.0%（71/78）.The median operation time was 58.3 min（range 20-210 min）.Minor bleeding 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 3.8%（3/78）,two were treated conservatively,and one was referred to surgery.Fifty two patients were followed up for 2 to 17 months.No residue or recurrence of the lesions was found.【Conclusion】 ESD is a safe and effective treatment for upper gastrointestinal lesions,with which large lesions can be resected in an en bloc fashion and pathological information can be provided.

关 键 词：胃肠道 内镜 内镜黏膜下剥离术 

分 类 号：R571[医药卫生—消化系统] R573[医药卫生—内科学]