老年人胃食管黏膜病变内镜黏膜下剥离术的安全性探讨

目的 探讨60岁以上老年人胃食管黏膜病变内镜黏膜下剥离术(ESD)治疗的安全性.方法 经胃镜检查发现胃食管扁平隆起性病变的老年患者36例,病理活检及内镜超声检查证实为异型增生14例,早期癌9例,平滑肌瘤13例.在清醒状态下,应用改良的针状钩刀、IT刀及电凝电切技术剥离病灶,应用去甲肾上腺素冰生理盐水、氩气刀、金属夹等处理创面.术后4周复查胃镜评价创面愈合及病灶残留情况.结果 36例中,ESD完整切除病灶29例(80.6%),借助圈套器切除7例(19.4%).术中穿孔3例(8.3%),经金属夹闭合、胃管引流、禁食、抑酸和抗感染等治疗,5～7d恢复;术后2h出现呕血1例(2.8%),经内镜下金属夹止血.结论 对老年胃食管黏膜病变患者行ESD治疗是安全有效的.

The study on safety of endoscopic submucosal dissection in elderly patients with lesions of gastroesophageal mucosa

Objective To investigate the safety of endoscopic suhmucosal dissection (ESD) in elderly patients with lesions of gastroesophageal mucosa. Methods Thirty-six elderly patients with flat elevation lesion of gastroesophageal mucosa were studied from July 2007 to May 2008. There were 14 cases with dysplasia, 9 cases with early carcinoma and 13 cases with leiomyoma confirmed by pathologic biopsy and endoscopic ultrasonography. All the patients were treated under consciousness condition, and the focus of lesion were completely resected with improved hook knife, IT knife and electrocoagulation or electro-cutting technique. The wound surface was managed with noradrenaline added in ice physiological saline, argon beam coagulator and metal clips. After operation, they were treated by abrosia, acid suppression and mucosa protection. The conditions of wound healing and residual lesions were reexamined four weeks after operation. Results Among the 36 patients (19 males and 17 females), there were 29 patients(80.6%) with complete focus ablation by ESD and 7 patients (19.4%) with resection by snare. Three cases (8.3%) of perforation occurred during operation and the perforations were treated with metal clips. After inserting stomach tube for fasting and anti-infection treatment for 5-7 days, all the three cases were recovered. One case(2.8%)had hematemesis 2 hours after operation and bleeding was stopped by endoscopic metal clip. Conclusions ESD is a safe and effective therapeutic tool in elderly patients with lesions of gastroesophageal mucosa.