内镜黏膜下剥离术在诊治胃上皮内瘤变中的价值  

The value of endoscopic submucosal dissection in the diagnosis and treatment of gastric intraepithelial neoplasia

作　　者：徐亚[1] 陈志荣[1] 闵寒[1] 陆忠凯[1] 

机构地区：[1]南京医科大学附属苏州医院消化内科,江苏苏州215001

出　　处：《胃肠病学和肝病学杂志》2014年第11期1283-1286,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）在诊治胃上皮内瘤变（gastric intraepithelial neopla-sia,GIN）中的价值.方法 回顾性分析2012年1月-2013年8月南京医科大学附属苏州医院收治的32例行ESD治疗的GIN患者,并比较ESD治疗前后的病理差异,总结整块病灶切除率、切除病灶直径、手术操作时间、术中术后并发症、复发率.结果 （1）完整切除率100％ （32/32）;切除病灶直径1.1 ～5.2 cm,平均（2.3±1.2）cm;从黏膜下注射至完整剥离结束时间10 ～75 min,平均（35.0±16.5） min;术中无穿孔发生,术中出血率12.5％ （4/32）,予以止血等对症治疗后好转.无迟发性出血,32例患者均完成3～12个月随访,无病变残留或复发.（2）32例GIN患者行ESD治疗,术前低级别GIN 26例,高级别GIN 6例.行ESD后病理发现26例低级别GIN中有1例黏膜内癌,3例高级别GIN;6例高级别GIN中有2例黏膜内癌,癌变发现率为9.4％（3/32）,总病理升级率为18.8％（6/32）.结论 ESD治疗GIN能及时发现胃早癌,且能安全、有效地根治.Objective To investigate the value of endoscopic submucosal dissection （ESD） in the diagnosis and treatment of gastric intraepithelial neoplasia （GIN）.Methods Thirty-two cases of patients with GIN were collected and retrospectively analyzed from Jan.2012 to Aug.2013 in Suzhou Hospital Affiliated to Nanjing Medical University.The pathological difference of pre-ESD and post-ESD was compared.The common indexes about ESD operation including the whole-lesion dissection rate,average diameter of lesions,average time of operation,complications of ESD and recurrence rate were summarized.Results （1） The whole-lesion dissection rate was 100％ （32/32）,average diameter of lesions （2.3 ± 1.2） cm （1.1 ～ 5.2 cm）,average time of operation （35.0 ± 16.5） min （10 ～ 75 min）,bleeding rate during operation was 12.5 ％ （4/32）,there was no perforation,and there was no residue or recurrent lesions after 3 ～ 12months follow-up.（2） There were 26 cases of low grade GIN and 6 cases no high grade GIN in the 32 cases.After ESD operation,1 case of intramucosal carcinoma and 3 cases of high grade GIN in the 26 cases of low grade GIN diagnosed pre-operation were found.And 2 cases of intramucosal carcinoma in the 6 cases of high grade GIN were found.The discovery rate of early-stage carcinoma was 9.4％ （3/32）,and the total pathological upgrade rate was 18.8％ （6/32）.Conclusion ESD can timely find the early-stage carcinoma in the GIN lesions,and cure the gastric intraepithelial neoplasia lesions safely and effectivly.

关 键 词：内镜黏膜下剥离术 胃上皮内瘤变 早癌 

分 类 号：R573[医药卫生—消化系统]