内镜下黏膜剥离术治疗黏膜下隆起性病变的价值

目的:探讨内镜黏膜下剥离术(endos copic submucosal dissection,ESD)治疗消化道黏膜下隆起性病变的疗效和安全性。方法:对内镜发现的15例消化道黏膜下肿物进行超声内镜检查(15例病变均位于黏膜下层),应用TT刀、HOOK刀、IT刀等工具进行内镜黏膜剥离术(ESD)治疗。先用1∶10000肾上腺素加美蓝在黏膜下注射抬高病变,使病变与肌层相分离。预切开病变周围黏膜,剥离病变下方黏膜下层结缔组织,再对肿瘤进行钝性分离,完整切除病变。结果:病变最大直径为6~18mm,平均8mm,15例均成功完成ESD治疗,手术时间26~61min(平均41min)。所有ESD剥离病变包膜完整,基底和切缘未见病变累及。本组ESD病例未见术后出血、穿孔等并发症。结论:ESD治疗消化道黏膜下隆起性病变安全、有效,可以完整切除消化道黏膜下病变,提供完整的病理诊断资料。

Effect of endoscopic submucosal dissection on submucous bulging lesion

Objective：To discuss the effect and safety of endoscopic submucous dissection on treating submucous bulging lesion in digestive tract.Methods：Ultrasound endoscopic examination was done to 15 submucous abnormal protuberance in digestive tract（all were located in submucous layer）,then ESD was employed by tools such as TT knife,HOOK knife and IT knife.1∶10000 epinephrine with methylene chloride was injected under mucous membrane to raise lesion position and separate them from muscular layer.Cut the mucous membrane around the pathological changes for pretreatment,peeled off connective tissue in lower submucous layer,bluntly separated the tumor,and cut off the mass wholely.Results：The maximum diameter of lesion was 6-18 mm,average 8 mm.All 15 cases were treated with ESD successfully with operating time 16-61 min（average 41 min）.All mass peeled off had complete capsule,intact foundation and cutting edge.No complications such as postoperative hemorrhage and perforation occurred.Conclusion：ESD is safe and effective for treating submucous bulging lesion.It can cut off tumor in digestive tract completely and provide valuable pathological data for diagnosis.