摘要
目的:评价内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗胃、结直肠黏膜病变有效性及安全性.方法:对2011-02/2013-04在大连医科大学附属第一医院行ESD治疗的42例胃肠黏膜病变患者治疗效果及并发症进行回顾性分析.结果:2例因黏膜下注射抬举征阴性,中转手术治疗.40例患者共46处病变完成ESD治疗,一次性整块切除率为89.1%(41/46),组织学治愈性切除率为78.3%(36/46),出血率20%(8/40),7例术中少量出血(17.5%),1例术后24h内出血(2.5%),所有出血患者经内镜下治愈.术中穿孔7.5%(3/40),其中2例病例经内镜下治愈,1例穿孔病例经外科手术治疗,无死亡病例.无消化系狭窄及肺炎病例.术后随访2mo-2年,1例术后6mo复发,复发率2.7%,再次行ESD治疗,无残留及淋巴结转移病例,无死亡病例.结论:ESD以其高整块切除率及组织学治愈性切除率,较低的出血、穿孔等并发症发生率,低残留、复发率,并且创伤小,恢复快,最大限度保留胃肠结构及功能,同次手术可处理多处病变、同一患者可多次实施ESD手术等优点,成为消化系黏膜病变的重要治疗方法.并且一旦出现出血、穿孔等并发症,大多可经内镜下治愈.ESD是一种安全有效的治疗方法.
AIM： To evaluate the efficacy and safety of endo- scopic submucosal dissection （ESD） in the treat- ment of gastrointestinal mucosal lesions. METHODS： Therapeutic effect and complica- tions of ESD were retrospectively evaluated in 42 patients with gastrointestinal mucosal lesions treated in the First Affiliated Hospital of Dalian Medical University from February 2011 to April 2013. RESULTS： Two cases were converted to surgi- cal treatment due to negative lifting sign during submucosal injection. ESD was performed in 40 patients. The en-bloc resection rate was 89.1% （41/46）, and the histologically curative resection rate was 78.3% （36/46）. Bleeding rate was 20.0% （8/40）. Among patients who developed bleed-ing, seven had little bleeding during ESD （19.5%）, one developed bleeding within 24 h after ESD （2.4%）, and successful endoscopic hemostasis was achieved in all cases. Three patients devel- oped perforation during ESD （7.5%）, of whom two were enclosed successfully by clips, and one was cured by surgery. There was no diges- tive tract stenosis or postoperative pneumonia. Thirty-six of forty patients were followed for two months to two years （average 11.4 too）. One case （2.7%） had local recurrence six months after ESD and was treated by ESD again. No residual or metachronous lesions were found. There were no distant metastases or deaths. CONCLUSION： ESD is the most important treat- ment for gastrointestinal mucosal lesions for its high rate of en-bloc resection and histological curative resection rate, lower incidence rate of complications such as hemorrhage, perforation, low-residue and recurrence rate. Once compli- cations such as bleeding or perforation appear, most of them can be cured by endoscopy.
出处
《世界华人消化杂志》
CAS
北大核心
2013年第19期1866-1870,共5页
World Chinese Journal of Digestology
关键词
内镜黏膜下剥离术
胃肠黏膜病变
安全性
有效性
Endoscopic submucosal dissection
Gastrointestinal mucosal lesions
Efficacy
Safety
