水下内镜切除术在消化道肿瘤治疗中的应用 （附452例综合分析）*

目的探讨水下内镜切除术在治疗消化道肿瘤中的疗效及安全性。方法通过美国国立医学图书馆搜索引擎PubMed,分别以"underwater endoscopic mucosal resection","underwater endoscopic submucosal dissection","underwater peroral endoscopic myotomy"为关键词,检索出相关文献,汇总病例并进行分析。结果共检索出40篇相关文献,纳入452例病例,其中水下内镜下黏膜切除术(UEMR)413例,水下内镜黏膜下剥离术(UESD)37例,水下经口内镜下肌切开术(UPOEM)2例。413例UEMR患者一共有468个病灶,切除成功率为98.5%,其中整块切除率达61.1%,整块切除者的R0切除率为94.3%;37例UESD患者共有39个病灶,所有病灶均经UESD完整剥离;2例UPOEM患者成功行水下黏膜下隧道建立及肌切开。全组术后并发症较低,以出血多见,其他包括穿孔、十二指肠腔狭窄、低钠血症、吸入性肺炎和自限性息肉切除术后综合征。结论水下内镜切除技术是一项较为安全有效的治疗手段,易于掌握且操作方便。今后仍需要更多的临床研究以及长期随访资料,以明确水下内镜切除技术与常规内镜下黏膜切除术(EMR)或内镜黏膜下剥离术(ESD)相比的优势及适应证,便于临床应用及推广。

Clinical analysis of underwater endoscopic resection in treatment of gastrointestinal tumors (452 cases)*

Abstract: Objective?To evaluate the effects and safety of underwater endoscopic resection for gastrointestinal tumors.?Methods?After searching the PubMed, a search engine of the National Library of Medicine, Underwater endoscopic mucosal resection, Underwater endoscopic submucosal dissection and Underwater peroral endoscopic myotomy, respectively, relevant documents were retrieved and the cases were summarized.?Results?40 related articles were retrieved and enrolled in 452 cases, including 413 cases of underwater endoscopic mucosal resection (UEMR), 37 cases of underwater endoscopic submucosal dissection (UESD), underwater peroral endoscopic myotomy (UPOEM) in 2 cases. There were 468 lesions in 413 UEMR patients, with a successful resection rate of 98.5%. The en bloc resection rate was 61.1%, and the R0 resection rate was 94.3% in the en bloc resection; There were 39 lesions in 37 UESD patients and all the lesions were completely dissection by UESD; 2 cases of UPOEM were performed to create a tunnel and underwater myotomy successfully. Postoperative complications included bleeding, perforation, duodenal stricture formation, hyponatremia, aspiration pneumonia and postpolypectomy syndrome.?Conclusion?Underwater endoscopic resection appears to be an easy, safe and effective technique. In the future, more clinical studies and long-term follow-up data are needed to clarify the advantages and indications of underwater endoscopic resection compared with conventional EMR or ESD.