内镜下黏膜切除术在消化道肿瘤中的应用

目的探讨内镜下黏膜切除术（EMR）在消化道肿瘤治疗中的价值。方法胃镜检查发现病灶后，利用超声内镜确定病变范围及浸润层次，对病灶位于黏膜及黏膜下层的消化道早期癌、癌前期病变、黏膜下肿瘤及宽基息肉的患者行EMR治疗。结果20例早期癌及中、重度异型增生者行EMR治疗，随访1-37个月，无1例复发及癌变，其中2例自行追加外科手术，术后病理均阴性。消化道黏膜下良性肿瘤8例，随访1-37个月，无1例复发。宽蒂息肉7例随访1-41个月，原部位无复发。术中并发出血2例、术后出血1例，均在内镜下或内科保守治疗止血成功。结论采用内镜下黏膜切除术治疗消化道早期癌、癌前期病变、黏膜下肿瘤及宽基息肉等，是一种可选择的、安全、有效的治疗方法，尤其适用高龄、合并有严重疾病及多次手术后不能再次外科手术的患者。

Application of endoscopic mucosal resection to gastrointestinal tumor

Objective] To study the valuation of the endoscopic mucosal resection (EMR) in the treatment of the gastrointestinal neoplastic lesions. Methods] After detected by endoscope, the lesions were located by endoscopic ultrasonograpy. So were their properties, extent and layers. To those lesions in mucosa and submucosa layer, EMR therapy were applied for early carcinoma, precancerous lesion, submucosal neoplasm and wide-based polyps. Result] 20 cases of early cancinoma, moderate or severe dysplasia received EMR therapy. During the 1 to 37 months follow-up, no recurrence or depravation happened. 2 of them received carcinoectomy, and pathological report were negative. 8 cases of gastrointestional benign tumors received EMR, and none of them recurred during the 1 to 37 months follow-up period. None of 7 wide-based polyps cases recurred during the 1 to 41 months follow-up. 3 cases had the complication of hemorrhage; 2 cases happened during EMR therapy and 1 in perisurgery period. All of the 3 cases were cured by endoscopic therapy or comservation therapy. Conclusion] EMR is a safe and effective method to treat the early carcinoma, precancerous lesion, submucosal neoplasm and wide-based polyps in mucosa and submucosa layer, especially to those aged patients who are complicated with severe diseases or those post-surgical patients who are too weak to receive another surgical treatment.