剪状刀在复杂病变内镜黏膜下剥离术中的应用

目的评价剪状刀在内镜黏膜下剥离术（ESD）应用中的疗效及安全性。方法对2010年5月至2012年5月间34例患者的36次复杂ESD治疗中应用剪状刀进行黏膜剥离，观察疗效及并发症发生情况。结果36次ESD均完整剥离病变，完全切除率为91．7％，发生延迟出血2例（占5．6％），给予内镜下止血后出血停止，无穿孔发生。患者平均住院5d，6例患者于术后6个月、12个月术后复查，创面愈合良好，未见肿瘤复发及残余，其余患者均在随访中。结论剪状刀的应用使得复杂病变内镜黏膜下剥离术易于操作、便于剥离，提高手术安全性、有效性的同时无需其他手术器械辅助，可降低手术费用，值得推广应用。

The application of scissors knife in difficult endoscopic submucosal dissection

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） with scissors knife in difficult cases. Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife. The complications and follow- up outcomes were recorded. Results All lesions were removed successfully with an en bloc resection rate at 91.7%. Delayed bleeding occurred in 2 patients （5.6%） , and both of them were cured sucessfully with en- doscopy. No perforation happened and the average hospitalization time was 5 days . Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions. Other patients are under follow-up now. Conclusion The scissors knife is easy to manipulate, which can ensure the safety and efficiency of ESD.