内镜黏膜下剥离术治疗20例胃肠道间质瘤

目的探讨内镜黏膜下剥离术（ESD）治疗胃肠道间质瘤（GIST）的疗效和安全性。方法对来源于肌层、内镜超声（EUS）诊断GIST的20例患者应用头端弯曲的针形切开刀进行ESD治疗：（1）黏膜下注射生理盐水；（2）预切开病变周围黏膜；（3）剥离黏膜下层组织显露肌层GIST，一次性完整切除病变。结果共计20例来源于肌层的GIST，其中12例位于胃底，1例位于胃窦，3例位于胃体，4例位于直肠。病变直径0．5—3．2（平均1．6）cm。19例（95．0％）患者的病变全部完整剥离，1例ESD剥离病变后创面仍有肿瘤残留，后行外科手术扩大切除治疗。ESD手术时间60－150（平均87．5）min。全组未出现ESD术后出血。3例（15．0％）ESD治疗中发生穿孔，应用金属夹成功闭合裂孔，均未中转开腹手术修补。术后随访期2—12个月，19例病变完整剥离者未见肿瘤复发。结论ESD治疗小的、来源于肌层的GIST安全、有效，病变可以被完整切除并提供完整的病理学诊断资料。     

内镜黏膜下剥离术治疗消化道黏膜下肿瘤

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗消化道黏膜下肿瘤(submucosal tumor,SMT)的疗效和安全性。方法对内镜发现的19例消化道SMT(食管6例,胃6例,十二指肠1例,乙状结肠1例,直肠5例)进行超声内镜检查(18例病变位于黏膜下层,1例位于固有肌层),应用头端弯曲的针形切开刀进行ESD治疗。黏膜下注射生理盐水抬高病变,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,完整切除病变。结果病变最大直径0.5～3.0cm(平均1.6cm)。18例成功完成ESD治疗,手术时间15～105min(平均45min)。2例ESD术中出现内镜难以控制的大出血,1例成功保守治疗(三腔管食管囊压迫),1例转开腹手术。无术后出血。ESD穿孔3例:2例术中消化道穿孔(十二指肠球部和胃底),应用金属夹缝合成功,未转开腹手术;1例直肠类癌剥离深至肌层,术后出现皮下气肿,保守治疗气肿减退。所有ESD剥离病变包膜完整,基底和切缘未见病变累及。结论ESD治疗消化道SMT安全、有效,可以完整切除消化道黏膜下层病变,提供完整的病理诊断资料。对于来源于固有肌层的SMT,应慎行ESD。     

内镜黏膜剥离术治疗上消化道广基息肉、黏膜下肿瘤的临床疗效

目的：探讨内镜下黏膜剥离术( ESD)治疗上消化道广基息肉、黏膜下肿瘤的疗效和安全性。方法：对内镜发现的58例上消化道隆起性病变进行超声内镜检查（25例病变位于黏膜层,16例位于黏膜肌层,17例位于黏膜下层）,应用HOOK刀及IT刀行内镜下黏膜剥离术治疗。黏膜下注射生理盐水抬高病变,使病变与肌层分离,预切开病变周围黏膜,剥离病变下方黏膜下层结缔组织,完整切除病变。结果：58例患者均成功完成ESD治疗,病变大小0.4~3.4 cm（平均1.5 cm）,手术时间15~95 min (平均40 min),无出血、穿孔等并发症。所有ESD剥离病变包膜完整,基底和切缘未见病变累及。结论：ESD治疗上消化道广基息肉、黏膜下肿瘤安全、有效,可以完整切除病变,提供完整的病理诊断资料。     

食管胃交界部固有肌层来源黏膜下肿瘤内镜下切除方法的选择与评价

目的评价以内镜黏膜下剥离术（ESD）为基础的各种内镜切除技术在食管胃交界部（EGJ）固有肌层来源黏膜下肿瘤（SMT）治疗中的临床价值和适应证的选择。方法回顾性分析复旦大学附属中山医院内镜中心所有接受内镜下切除治疗的患者资料库．筛选出2007年3月至2011年6月间经内镜下超声或CT证实固有肌层来源的EGJ处SMT患者143例。详细记录患者的临床病理资料、内镜切除方法、完整切除率、并发症发生率及术后随访资料。结果143例患者中男74例,女69例,平均年龄49．1岁。135例（94-4％）病变成功完成内镜下整块切除,其中接受内镜黏膜下挖除术126例,无腹腔镜辅助的内镜全层切除术6例,内镜经黏膜下隧道肿瘤切除术3例：另外8例肿瘤于内镜下部分切除后,基底部尼龙绳套扎。肿瘤平均直径为17．6mm．平均手术时间45．1min．平均出血量50．0ml。术中穿孔6例,贲门黏膜撕裂1例。均通过内镜下处理及保守治疗好转。术后病理示,平滑肌瘤121例,胃肠间质瘤20例。颗粒细胞瘤1例．肌间脂肪瘤1例。术后经3。48个月的随访,未见局部复发和远处转移病例。结论在EGJ固有肌层来源SMT治疗中．各种内镜切除方法均安全有效．临床医师需根据肿瘤的临床特征具体选择．     

内镜下治疗胃肠道神经内分泌肿瘤40例

目的评价超声内镜及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃肠道神经内分泌肿瘤(gastrointestinal neuroendocrine neoplasms,GI-NENs)的临床价值。方法我院2011年5月~2016年5月采用ESD治疗GI-NENs 40例(食管1例,胃2例,十二指肠1例,阑尾1例,结肠2例,直肠33例),先在内镜下对病灶边缘进行环形标记,然后用甘油果糖靛胭脂肾上腺素稀释液黏膜下注射后环周切开,最后沿固有肌完整剥离切除肿物。结果 40例术前超声内镜检查病变均局限于黏膜层至黏膜下层,术后病理示1例侵及肌层,超声内镜术前判断病变累及层次的正确率为97.5%(39/40)。术中术后无出血、穿孔等并发症。术后病理完整切除率为97.5%(39/40),G1级34例,G2级6例。33例随访平均30.4月(2~56个月),均未见局部复发和远处转移。结论 GI-NENs好发于直肠,以G1和G2级常见。ESD是治疗高分化神经内分泌瘤安全有效的方法,超声内镜能有效指导手术方案的选择。     

内镜黏膜下剥离术治疗大肠巨大平坦息肉18例分析

目的探讨内镜黏膜下剥离术(ESD)治疗大肠巨大平坦息肉的应用价值。方法对2006年8月至2007年3月复旦大学附属中山医院应用肠镜检查发现的18例长径>2cm大肠平坦息肉进行染色、放大内镜观察和微探头超声检查,应用头端弯曲的针形切开刀进行ESD治疗。(1)黏膜下注射生理盐水抬高病变,使病变与肌层相分离;(2)预切开病变周围黏膜;(3)剥离病变下方黏膜下层结缔组织,完整切除病变。结果18例大肠巨大平坦息肉,直肠11例,乙状结肠3例,降结肠1例,结肠肝曲1例,升结肠1例,盲肠1例。病变长径2.0~5.2cm(平均3.1cm)。所有病例术后全部得到病理证实。所有病变全部一次大块、完整剥离成功,ESD成功率100%。ESD手术时间(自黏膜下注射至完整剥离病变)55~115min,平均75min。ESD术中未出现肠镜下无法控制的大出血,术后无一例出现须再次肠镜下治疗的出血。ESD治疗中1例剥离深至肌层,出现阴囊气肿和颈部皮下气肿,保守治疗后气肿减退。1例剥离病变后见肠壁外脂肪,应用金属夹成功缝合创面。ESD穿孔发生率11.1%(2/18)。术后随访12例,平均随访期4.2个月,无一例病变残留和复发。结论ESD治疗大肠巨大平坦息肉安全、有效,可以完整切除病变,提供完整的病理学诊断资料。     

内镜经黏膜下隧道肿瘤切除术在胃固有肌层肿瘤中的应用与评价

目的评价内镜经黏膜下隧道肿瘤切除术（STER）治疗来源于固有肌层的胃黏膜下肿瘤（SMT）的临床应用价值。方法回顾性分析2010年9月至2011年12月间在复旦大学附属中山医院内镜中心接受STER术的23例来源于固有肌层的胃SMT患者的临床病理资料。结果男性13例。女性10例,年龄28-73（平均52．4）岁。23例胃SMT中贲门近胃体侧11例,贲门近胃底侧4例,胃体小弯5例,胃窦大弯侧3例。来源于固有肌层浅层14例,深层9例,其中5例与浆膜层粘连,密不可分。23例STER手术均获成功,所有SMT均完整切除。切除病变直径1．5-3．2（平均2．1）cm：肿瘤切除至黏膜切口完整缝合时间30-125（平均54．8）min。术后病理诊断：平滑肌瘤10例,胃肠间质瘤8例,血管球瘤2例,神经鞘膜瘤2例,钙化性纤维性肿瘤1例;切缘均为阴性。发生气胸伴皮下气肿3例次,气腹5例次,左侧膈下积液伴继发感染1例次,均予保守治疗痊愈。术后无迟发性消化道出血、消化道瘘、黏膜下隧道内积血积液和感染病例。随访3-18个月,无一例病变残留或复发。结论STER治疗适宜部位的胃固有肌层SMT安全、有效。能够一次性完整切除病变,提供完整的病理学诊断资料,且可以迅速恢复消化道完整性,避免消化道瘘的发生。     

内镜黏膜下剥离术治疗直肠类癌

目的探讨内镜黏膜下剥离术（ESD）治疗直肠类癌的应用价值。方法肠镜发现直肠黏膜下肿块后进行微探头超声检查，对诊断为类癌者应用头端弯曲的针形切开刀进行内镜黏膜下剥离术治疗：（1）黏膜下注射生理盐水抬高病灶，使病灶与肌层分离；（2）预切开病灶周围黏膜；（3）剥离病变下方黏膜下层结缔组织，完整切除病灶。结果5例直肠类癌患者，肿瘤直径0.4～1.2（平均1．1）cm，均成功完成ESD治疗。ESD手术时间（自黏膜下注射至完整剥离病变）20-45（平均35）min；术中创面少量出血，均经电凝、氩离子血浆凝固和止血夹成功止血。不需再次肠镜下止血。1例剥离深至肌层，出现皮下气肿，保守治疗好转。术后全部经病理确诊。基底和切缘未见病变累及。1个月后肠镜复查，创面基本愈合。结论ESD是治疗直肠类癌的新方法．以往需要外科手术切除的肿瘤通过ESD可以达到同样的治疗效果。     

结直肠内镜黏膜下剥离术后电凝综合征临床特征及危险因素分析

目的 探讨结直肠内镜黏膜下剥离术（ESD）术后电凝综合征（PEECS）的临床特点和危险因素,为ESD围手术期处理提供证据。方法 回顾性分析2008年1月至2014年7月复旦大学附属中山医院收治的412例经内镜黏膜下剥离术治疗结直肠黏膜下肿瘤的病人。分析病人的性别、年龄、病变大小、位置和起源等因素与PEECS的关系。结果 28例（6.8%）病人并发结直肠ESD术后PEECS。单因素分析显示肿瘤大小、肿瘤位置和肿瘤起源是危险因素。多因素Logistic回归分析结果显示肿瘤直径（＜20 mm vs. ≥20 mm）、肿瘤位置（结肠 vs. 直肠）和肿瘤起源（黏膜层或黏膜下层 vs. 固有肌层）为PEECS发生的独立危险因素（P＜0.05）。结论 肿瘤直径≥20 mm、肿瘤位于结肠和肿瘤起源于固有肌层是ESD切除结直肠黏膜下肿瘤术后病人并发PEECS的独立危险因素。对于存在这些危险因素的病人,术后应予严密观察和谨慎的围手术期护理。     

圈套器联合钛夹牵引法在内镜切除胃黏膜下肿瘤术中的应用北大核心CSCD

目的评估圈套器联合钛夹牵引法在内镜切除胃黏膜下肿瘤术中的应用价值。方法回顾性分析2019年1月~2020年6月49例胃黏膜下肿瘤行圈套器联合钛夹牵引辅助内镜切除的资料。肿瘤位于胃底16例,胃体18例,胃窦7例,胃角8例。肿瘤长径1.0~3.5 cm,中位数2.3 cm。肿瘤起源于黏膜肌层或黏膜下层11例,固有肌层38例。奥林巴斯Dual刀或IT刀切除瘤体表面黏膜暴露瘤体,圈套器联合钛夹牵引瘤体切开的一侧缘,腔内生长为主的瘤体采用非全层切除,腔外生长为主的瘤体采用全层切除。结果非全层切除18例,全层切除31例,圈套器联合钛夹牵引法均能有效暴露手术视野,均整块切除,术后住院时间3~8 d,中位数5 d。未发生术中和术后严重并发症。49例随访时间25~39个月,(32.0±4.2)月,胃镜及全腹部增强CT未见复发。结论圈套器联合钛夹牵引法是内镜切除黏膜下肿瘤有效的辅助方法,高效,安全。     

Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer: a preliminary analysis of appropriate indications

Background

Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of gastrointestinal epithelial tumors. However, the treatment of gastric subepithelial tumors (SETs) that originate from the muscularis propria layer still depends primarily on surgical techniques. We evaluated the appropriate indications for ESD in the treatment of SETs that originate from the muscularis propria layer.

Methods

Thirty-five patients with gastric SETs that originate from the muscularis propria layer who underwent ESD were enrolled, and the charts were retrospectively reviewed to investigate the parameters predictive complete resection and complications.

Results

The mean age of the patients was 54.15 ± 9.3 years, and the male/female ratio was 2:3. Twenty-eight of the 35 SETs (85.7 %) were movable, and 15 (45.7 %) had a positive rolling sign. The most frequent location of the SETs was high body (n = 14). The most common pathological diagnoses were leiomyoma (60 %) and gastrointestinal stromal tumor (28.6 %). The complete resection rate was 74.3 %. A positive rolling sign (p = 0.022) and small tumor size (≤20 mm; p = 0.038) were significantly associated with complete resection. Two patients (6.1 %) developed perforations that required surgical treatment; their SMTs were neurogenic tumors with fixed lesion. Tumor mobility was significantly associated with perforation (p = 0.017).

Conclusions

The ESD method appears to be relatively safe for use in the complete resection of SETs that originate from the muscularis propria layer. Small tumor size (≤20 mm) and a positive rolling sign are appropriate indications for ESD.     

Complete defect closure of gastric submucosal tumors with purse-string sutures

Background

Gastric submucosal tumors (SMTs) originating from the muscularis propria layer are treated endoscopically. Successful closure of the wall defect is a critical step. This study evaluated the safety and feasibility of the endoscopic purse-string suture (EPSS) method using an endoloop and several metallic clips after endoscopic full-thickness resection (EFTR) or perforation due to endoscopic submucosal dissection (ESD).

Methods

From December 2009 to April 2013, 30 patients with SMTs originating from the muscularis propria layer who received EFTR or ESD were retrospectively analyzed. After successful tumor resection, an endoloop was anchored onto the circumferential margin of the gastric defect with several metallic clips and tightened gently. Patient characteristics, tumor size, en bloc resection, and postoperative complications were evaluated.

Results

For all 30 patients, EPSS was successfully performed after EFTR or perforation due to ESD. The mean diameter of the resected specimen was 1.9 cm. No severe complications occurred during or after the procedure. The lesions were healed 1 month after the procedure, as confirmed endoscopically.

Conclusion

The EPSS method using an endoloop and clips is an effective and safe technique for closing the gastric defect after EFTR or perforation due to ESD.     

内镜黏膜下挖除术治疗胃固有肌层肿瘤116例临床分析

目的探讨内镜黏膜下挖除术（ESE）治疗胃固有肌层肿瘤的安全性及疗效。方法以2006年7月至2011年3月期间浙江省台州医院对起源于胃固有肌层的黏膜下肿瘤而行ESE治疗的116例患者为研究对象,分析术中、术后并发症及相应治疗情况,术后对上述病例进行胃镜随访。结果成功挖除肿瘤112例（96．6％）,手术时间（51．9±16.3）min。术中出血9例（7．8％）,术中穿孔20例（17．2％）。术后出血3例（2．6％）,需外科干预5例（4．3％）,其中术中4例,术后1例。术后未出现腹腔脓肿。腹膜炎等其他并发症;ESE术后平均住院6．1d;中位随访时间12个月,随访期内未发现肿瘤残留及复发。结论ESE治疗胃固有肌层肿瘤是安全可行的,近期疗效确切。     

Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria

Background and aims

Based on our experience with endoscopic submucosal dissection (ESD) and new endoscopic techniques for endoscopic closure of iatrogenic upper gastrointestinal (upper-GI) perforations, we developed methods to remove upper-GI subepithelial tumors (SETs) originating from the muscularis propria by endoscopic?muscularis dissection (EMD). The aim of this study is to evaluate the clinical feasibility and safety of EMD.

Methods

31 patients with upper-GI SETs originating from the muscularis propria were treated by EMD. The EMD differed from ESD in (1) precutting the overlying mucosa above the lesion by using snare or longitudinal incision instead of circumferential incision, (2) dissecting the complete tumors away from submucosal and muscularis propria tissue by electrical dissection combined with blunt dissection, and (3) closing the wound with clips. Perforations occurring during dissection were closed by endoscopic methods.

Results

30 of 31 tumors were resected?completely (96.8 %). One esophageal lesion was resected partially because of severe adhesions with surrounding tissue. Mean resected tumor size was 22.1?mm?×?15.5?mm, and mean operation time was 76.8?min (range 15–330?min). Histological diagnosis was gastrointestinal stromal tumor (GIST) in 16 lesions [6 esophageal, 3 cardial, 7 gastric; 6 very low risk and 10 low risk according to the National Institutes of Health (NIH) risk classification] and leiomyoma in 15 lesions (8 esophageal, 4 cardial, 3 gastric). No patient developed delayed hemorrhage. Perforation occurred in four patients (12.9 %), all of which were managed successfully by endoscopic techniques. The mean follow-up time was 17.7?months (range 7–35?months). Follow-up found no tumor recurrence in any patient.

Conclusions

In this early experience, EMD appears to be a feasible and minimally invasive treatment for some patients with upper-GI SETs originating from the muscularis propria. Although there is a higher risk of perforation than with ESD, this will improve with extended practice, and perforations have become manageable endoscopically.     

食管胃黏膜活瓣式吻合术在食管下段癌、贲门癌切除中的应用

目的 探讨食管下段癌、贲门癌切除后食管胃黏膜活瓣式吻合术的方法及临床体会.方法 肿瘤切除及淋巴结清扫后消化道重建时,剥除食管肌层及胃浆肌层,使黏膜延长3～4 cm,然后食管黏膜与胃黏膜分层吻合,浆肌层包埋,包埋后吻合口置入胃腔内2-3 cm,切除胃超过2/3以上时辅以大网膜包绕吻合口.结果 施行该吻合方法38例,均恢复顺利,近期并发症3例,其中心律失常1例,肺部感染1例,乳糜胸1例,均经保守治疗全部治愈,随访半年后均可顺利进普通饮食,无吻合口狭窄及反流性食管炎表现.结论 食管胃黏膜活瓣式吻合术可有效地预防吻合口漏、狭窄、反流等并发症.     

Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria

Background

This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria.

Methods

Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips.

Results

EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60?C145)?min. The mean resected lesion size was 2.8 (range, 1.2?C4.5)?cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8?months; range, 6?C24?months).

Conclusions

EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.     

内镜下治疗早期胃癌及癌前病变的安全性分析

目的：探讨内镜下黏膜切除术（ endoscopic mucosal resection , EMR ）和黏膜剥离术（ endoscopic submucosal dissection,ESD）治疗早期胃癌及高级别上皮内瘤变的安全性。方法2009年2月～2014年4月,对胃镜、色素内镜、内镜窄带成像（ narrow band imaging ,NBI）、超声胃镜发现的早期胃癌及高级别上皮内瘤变85例进行EMR或ESD治疗。16例病变位于黏膜层、病灶＜5 mm者行EMR,其余行ESD。结果85例病变均成功切除,其中EMR 16例,ESD 69例。81例（95．3％）整块切除,4例（4．7％）分次切除。80例（94．1％）完整切除,5例（5．9％）病灶残留,其中切缘残留2例,基底部残留3例。手术时间15～69 min,平均40 min。术后病理证实高级别上皮内瘤变34例,黏膜内癌4例,黏膜上皮层癌3例,黏膜固有层癌11例,黏膜肌层癌23例,黏膜下层癌10例。术中出血3例（3．5％）,用氩离子凝固（argon plasma coagulation,APC）、热活检钳电凝或金属止血夹夹闭处理后成功止血。术中穿孔3例（3．5％）,均为ESD治疗者,穿孔直径＜10 mm,均用金属夹成功夹闭;术后迟发型出血7例（8．2％）,口服肾上腺素盐水及静脉药物止血、抑酸等治疗后缓解,无迟发型大出血。追加外科手术8例（9．4％）,其中5例因病灶残留,2例因ESD术后病理结果为病变侵及黏膜下层,无病灶残留,但病理类型为低分化腺癌,1例36岁患者ESD术后病理为中分化腺癌。无死亡病例。结论 EMR、ESD在治疗早期胃癌及高级别上皮内瘤变中完整切除率高,安全性高。     

Ex vivo pig training model for esophageal endosopic submucosal dissection (ESD) for endoscopists with experience in gastric ESD

Background

Esophageal endoscopic submucosal dissection (ESD) has developed in recent years because of its high rate of en bloc resection. However, for many endoscopists, technical difficulty and risks of complications are great barriers to performing esophageal ESD. In this study, we developed an original training model for esophageal ESD using isolated pig esophagus and assessed this ex vivo model in endoscopists with experience in gastric ESD.

Methods

Three endoscopists without experience in esophageal ESD but with some experience in gastric ESD performed esophageal ESD of artificial lesions in 10 consecutive sessions using this ex vivo model. The en bloc resection rate, operation time, number of muscularis propria layer injuries, and presence of perforation were recorded. We evaluated the effectiveness of this training in the three endoscopists by comparing results from the first five sessions (former period) with those from the last five sessions (latter period).

Results

All three endoscopists achieved en bloc resections in all trials. In the former period, injury to the muscularis propria layer for each of the three endoscopists occurred a mean of 2.2 (1–3), 0.6 (0–1), and 3.2 (1–6) times, respectively. Perforation occurred in one session performed by one endoscopist. In the latter period, the mean number of muscularis propria layer injuries for each of the three endoscopists decreased to 0.2 (0–1), 0.2 (0–1), and 0.8 (0–2), respectively. The time of operation shortened from 35.0 (25–40), 36.4 (30–50), and 29.8 (23–43)?min to 23.0 (16–31), 25.6 (23–28), and 29.2 (21–37)?min, respectively.

Conclusions

This original ex vivo training model was helpful to endoscopists with experience in gastric ESD in acquiring the basic skills for performing esophageal ESD.     

消化道类癌三种内镜治疗方法的比较

目的比较普通圈套器电切、内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗消化道类癌的有效性和安全性。 方法回顾性分析2006年1月至2015年6月病理符合消化道类癌患者的临床资料,比较普通圈套器电切治疗(普通圈套器电切组,12例)、内镜黏膜切除术治疗(EMR组,47例)和内镜黏膜下剥离术治疗(ESD组,39例)的组织学完全切除率、并发症,以及术后随访6～36个月观察其疗效。 结果内镜治疗消化道类癌的组织学完全切除率为78.57%(77/98)。普通圈套器电切组的组织完全切除率为66.67% (8/12),EMR组为82.98% (39/47),ESD组为76.92% (30/39),差异均无统计学意义 (P＝0.463)。仅1例ESD治疗后发生穿孔,其他患者未出现并发症。所有患者随访6～36个月,均未复发。 结论内镜治疗对病变未超过黏膜下层的小的消化道类癌是一种安全有效的方法。