内镜黏膜下剥离术在上消化道相关病变的应用  

Application of endoscopic submucosal dissection in upper gastrointestinal associated lesions

作　　者：孙会会[1] 陈莹[1] 许树长[1] 王志荣[1] 张霞[1] 

机构地区：[1]同济大学附属同济医院消化内科,上海200065

出　　处：《中国内镜杂志》2012年第8期799-804,共6页China Journal of Endoscopy

摘　　要：目的探讨内镜黏膜下剥离术(ESD)治疗上消化道黏膜及黏膜下病变的疗效和安全性。方法经胃肠镜及超声内镜检查确诊为上消化道黏膜及黏膜下病变患者26例(其中6例为黏膜病变、20例为黏膜下病变),应用内镜黏膜下剥离术治疗,并对病理、治疗效果进行评估,术后内镜随访1周～2年不等。结果 26例入选病例中食管9例,胃15例,残胃1例,十二指肠球部1例。治疗情况:22例完整剥离,4例部分剥离。术中4例少量出血、1例食管轻度穿孔经术中及术后保守治疗均有效,1例出血较大予以外科手术治疗。病理:平滑肌瘤8例,间质瘤1例,纤维瘤1例,异位胰腺3例,脂肪瘤2例,潴留囊肿1例,异型增生7例,癌变3例。完成随访10例,其中1例早期食管癌复发,其余愈后良好。结论 ESD治疗上消化道黏膜及黏膜下病变安全、有效,术前严格评估及术中对切除范围及深度严密把握对减少病灶残留和病变复发、降低并发症发生率尤为重要。[Objective] To evaluate the efficacy and safety of endoscopic submucosal dissection（ESD） in treatment of mucosal or submucosal lesions in upper digestive tract.[Methods] 26 patients were diagnosed lesions or submucosal lesions of upper digestive tract via endoscopies and endoscopic ultrasonography,which included 6 mucosal lesions and 20 submucosal lesions.They were treated with endoscopic submucosal dissection.The pathology and efficacy of the treatment were evaluated.Some patients were followed up using endoscopy for a period of time（ranging from 1 week to 2 years）.[Results] 26 enrolled cases included 9 cases of esophageal lesions,15 cases of gastric lesions,1 case of residual gastric lesion,and 1 case of duodenal lesion.Peeling situation：22 cases were completely dissected and 4 cases were partly dissected.During the treatment,there were little bleeding in 4 cases and mild perforation 1 case,but all received good prognoses with the conservative treatment in the operation or postoperation.Operative procedure was performed in only one case because of bleeding.Pathology results：8 cases were smooth muscle tumor,1 case was interstitialoma,1 case was fibrous tumor,3 cases were ectopic pancreas,2 cases were lipomas,1 case was cyst,7 cases were dysplasia and 3 cases were cancer.Following-up results：10 cases received follow-up,in which 1 case recurred and others achieved good outcomes.[Conclusion] For gastrointestinal mucosa and submucosal lesions,endoscopic submucosal dissection is safe and effective.Rigorous preoperative evaluation and exact determination of the range and depth of excision in operation are particularly important to reduce residual lesions,complications and disease recurrence.

关 键 词：内镜黏膜下剥离术 上消化道 黏膜及黏膜下病变 

分 类 号：R459.9[医药卫生—治疗学]