内镜下黏膜剥离术在高风险/高难度病例治疗中的应用  

Feasibility of endoscopic submucosal dissection for patients with high risk and high challenge

作　　者：周淑萍[1] 徐斌[1] 黄玉凯[1] 金铭[1] 

机构地区：[1]淮南市第一人民医院消化内科,安徽淮南232007

出　　处：《胃肠病学和肝病学杂志》2014年第12期1380-1386,共7页Chinese Journal of Gastroenterology and Hepatology

摘　　要：内镜下黏膜剥离术(ESD)已越来越多地应用于消化道早期肿瘤及癌前病变的微创治疗。与内镜下黏膜切除术(EMR)相比,ESD可完整切除病灶,切除较大病灶、平坦型病灶以及溃疡型病灶,从而利于完整的病理学诊断及减少复发,且相对外科手术来说,其安全性高、死亡率低、损伤小、恢复快,具有与外科手术类似的治疗效果,为消化道早期肿瘤的治疗开辟了新的途径。本文就ESD在切除特殊病灶(巨大肿瘤、十二指肠肿瘤、胃黏膜下肿瘤和咽喉癌)及在特殊患者(早期残胃癌、高龄、肝硬化和慢性肾功能衰竭血透患者)中的应用作一概述。Endoscopic submucosal dissection （ESD） has been more and more used for minimally invasive treatment of benign and early malignant lesions in the gastrointestinal tract. ESD has the advantage for en bloc removal of large, flat and ulcerative lesions, which makes it facilitates the histologic diagnosis of the completeness of resection and is asso- ciated with a lower recurrence rate compared with endoscopic mucosal resection （EMR）. Moreover, ESD can be per- formed safely and with comparable outcomes to surgery with less morbidity, smaller damage and quicker recovery be- cause of its organ-sparing nature when compared with conventional surgery. Therefore, ESD provides a brand-new ap- proach for the management of gastrointestinal lesions. This review focuses on ESD in the removal of special lesions （large lesions, duodenal tumors, gastric subepithelial tumors, mesopharyngeal and hypopharyngeal carcinomas） and in patients with elderly, early gastric cancer in the remnant stomach, liver cirrhosis and end-stage chronic renal failure on hemodialysis.

关 键 词：内镜黏膜下剥离术 咽喉癌 高龄 肝硬化 慢性肾功能衰竭 十二指肠肿瘤 早期残胃癌 

分 类 号：R57[医药卫生—消化系统]