内镜黏膜下剥离术治疗胃肠道黏膜下肿瘤的临床效果  

Clinical effect of endoscopic submucosal dissection in the treatment of gastrointestinal submucosal tumors

作　　者：吴宁 蔡徐帆 叶再元[2] Wu Ning;Cai Xufan;Ye Zaiyuan(Department of Endoscopy Center,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310022,China;Department of General Surgery,Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital(Affiliated People′s Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江树人大学树兰国际医学院附属树兰(杭州)医院内镜中心,杭州310022 [2]浙江省人民医院(杭州医学院附属人民医院)普通外科胃肠胰外科,杭州310014

出　　处：《中国医师杂志》2024年第8期1129-1132,共4页Journal of Chinese Physician

摘　　要：目的分析内镜黏膜下剥离术(ESD)治疗胃肠道黏膜下肿瘤(SMT)的临床效果。方法回顾性分析2023年1月1日至12月31日期间在树兰(杭州)医院内镜中心经ESD治疗的114例SMT患者的临床资料。观察术中黏膜切开刀使用情况、手术相关指标、术后恢复情况等。结果本组患者年龄22~84(61.0±12.0)岁,男62例,女52例。肿瘤位于食道5例、贲门2例、胃底11例、胃体7例、胃角3例、胃窦13例、结肠38例、乙状结肠11例、直肠24例。所有肿瘤均位于黏膜下层,良性病变55例,癌前病变44例,恶性肿瘤病变15例。所有患者均顺利完成手术,无严重并发症或死亡病例。术中使用Dual刀59例,手术费用5082.44~12515.51(8657.34±1471.23)元,住院总费用10878.02~32310.74(18934.47±4404.21)元;使用圈套器55例,手术费用3159.87~9970.71(5597.37±1587.78)元,住院总费用6985.92~40309.26(13807.12±5213.76)元。手术时间18~204(63.07±35.48)min。术中出血22例,术中穿孔8例,术后禁食48 h有36例,术后禁食72 h有78例,术后住院时间3~16(6.91±2.38)d。术后14例出现腹痛、腹胀和发热等并发症。术后5例患者因病理提示恶性肿瘤且浸润深度>500μm(位于结肠则>1000μm),行外科补救手术。结论ESD治疗SMT安全可行。针对不同大小的胃肠道SMT,各内镜中心和各手术医生应综合考虑肿瘤的特征、治疗的有效性和成本-效益的平衡等因素选择相应的手术类型和手术耗材。ObjectiveTo analyze the clinical efficacy of endoscopic submucosal dissection(ESD)in the treatment of gastrointestinal submucosal tumors(SMT).MethodsA retrospective analysis was conducted on the clinical data of 114 SMT patients who underwent ESD treatment at the Endoscopy Center of the Shulan(Hangzhou)Hospital from January 1,2023 to December 31,2023.The use of mucosal incision during surgery,surgical related indicators,and postoperative recovery were observed.ResultsThe age of the patients in this group ranged from 22-84(61.0±12.0)years old,with 62 males and 52 females.Tumors were located in 5 cases of esophagus,2 cases of cardia,11 cases of gastric fundus,7 cases of gastric body,3 cases of gastric angle,13 cases of gastric antrum,38 cases of colon,11 cases of sigmoid colon,and 24 cases of rectum.All tumors were located in the submucosal layer,with 55 cases of benign lesions,44 cases of precancerous lesions,and 15 cases of malignant tumor lesions.All patients successfully completed the surgery without any serious complications or deaths.During the operation,59 cases used Dual knives,the surgical cost was 5082.44-12515.51(8657.34±1471.23)yuan,the total hospitalization cost was 10878.02-32310.74(18934.47±4404.21)yuan;55 cases used snare devices,the surgical cost was 3159.87-9970.71(5597.37±1587.78)yuan,the total hospitalization cost was 6985.92-40309.26(13807.12±5213.76)yuan,the surgical time was 18-204(63.07±35.48)minutes;there were 22 cases of intraoperative bleeding,8 cases of intraoperative perforation,36 cases of fasting for 48 hours after surgery,78 cases of fasting for 72 hours after surgery,and the postoperative hospitalization time was 3-16(6.91±2.38)days.Postoperative complications such as abdominal pain,bloating,and fever occurred in 14 cases.After surgery,5 patients underwent surgical salvage surgery due to pathological indications of malignant tumors with infiltration depth>500μm(>1000μm in the colon).ConclusionsESD treatment for SMT is safe and feasible.For different sizes of gastrointestina

关 键 词：胃肠肿瘤 黏膜下肿瘤 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]