内镜黏膜下剥离术治疗胃食管广基病变的临床研究

目的 探讨内镜黏膜下剥离术（ESD）治疗胃食管广基底病变的疗效及安全性.方法 回顾性分析2012年1月～ 2014年1月我院应用电子食管胃镜发现的直径≥2.0 cm胃食管广基病变（息肉、癌前病变、早期局限性肿瘤）患者的临床资料,经超声内镜检查位于黏膜肌层以下（包括黏膜肌层）的病灶纳入选择,并行ESD治疗.结果 本组研究共64例患者,54例病灶位于胃内,10例病灶位于食管内,所有病变经ESD完整剥离,术后经病理证实标本基底及边缘均无病变组织残留.胃组：5例（9.26％）发生术中少量渗血,出血量2～10ml,予以电热活检钳电凝成功止血;1例（1.85％）患者术后8小时出现呕血,鲜红色,Hb从132g/L降至100 g/L,急诊胃镜止血成功.食管：病灶内均未见出血、穿孔、皮下气肿等并发症.随访58例,术后l,3,6个月复查胃镜,创面愈合良好,未见病变残留和复发.结论 ESD治疗胃食管广基病变安全、有效,并发症发生率低,能维持正常的生理结构.

Clinic Study of endoscopic submucosal dissection(ESD) for the treatment of gastroesophageal lesions with expansive floor

Objective To investigate the efficacy and safety of endoscopic submucosal dissection in the treatment of gastroesophageal lesions with expansive floor. Methods To retrospectively analysis gastroesophageal lesions with expansive floor（ polyp, early carcinoma and early localized tumor） , whose di- ameter was greater than 2 em detected by electronic gastroscope esophagus in Renmin Hospital of Wuhan University from Jan 2012 to Jan 2014. Lesions under and within the muscularis mucosae were recruited through endoscopic ultrasonography, and treated with ESD. Results Of 64 cases in our research,54 cases had lesions located in the stomach, 10 cases had lesions located in the esophagus. All lesions were suc- cessfully resected with ESD without residue in the incisal margin or the bottom of the lesions confirmed by pathological examination. In stomach cases, 5 cases （9.26%） had intraoperative oozing bleeding about 2-10 ml, and successfully received coagulation hemostasis by electric heating biopsy forceps. 1 case （1.85%） had hematemesis after 8 hours with ESD. Hemoglobin decreased from 132 g/L to 100 g/L, and got successful hemostasis by emergency endoscopy. No complications （bleeding, perforation or subcutane- ous） occurred in esophagus cases. 58 cases were followed up after ESD, they healed well without residue or recurrence confirmed by reviewed gastroscope in 1,3,6 months. Conclusions ESD is an effective and s~e method for treating gastroesophageal lesions with wide bases, it has low incidence rate of complication and can help the patients to maintain normal physiological structure.