内镜黏膜下剥离术在消化道病变中的应用

目的探讨内镜黏膜下剥离术（ESD）治疗消化道病变的操作方法、疗效及并发症等。方法采用前瞻性研究方法,按照入选标准选取食管、胃及结直肠病变患者53例,共治疗病变56处。依次进行标记、注射、环周切开、剥离、止血等步骤。切除标本回收送病理。所有病例均按计划内镜随访。结果所有56处病变均完整切除,术中出血3例：1例创面小动脉出血,内镜下钛夹止血;1例胃黏膜下持续出血,形成血肿,中转开腹行胃窦切除术;另1例胃体增生性息肉,病变完整切除,创面出血,热活检钳反复止血不成功,再以止血夹夹闭仍无效,术中血压下降,心率增快,遂急诊中转开腹止血手术。术后延时出血1例：1例直肠管状腺瘤ESD术后7 d大出血,经肛门缝扎止血。术中发现肠壁穿孔1例,中转开腹行肠壁修补术。53例患者均康复痊愈出院,无患者出现后遗症。53例患者平均住院时间为5 d。在随访2-30个月后不存在复发患者。结论 ESD治疗消化道病变是安全的,可以一次性完整切除较大病变,提供完整的病理学资料,且术后不易复发。缺点是操作时间长,技术难度较大,并发症较内镜黏膜下切除术（EMR）多。

Endoscopic submucosal dissection for gastrointestinal lesions

【Objective】To explorer the clinical efficacy and safety of endoscopic submucosal dissection（ESD） for the gastrointestinal tract diseases. 【Methods】53 cases of gastrointestinal tract diseases treated with endoscopic submucosal dissection were analyzed prospectively, including operation situation under endoscopy, complication and treatment, prognosis. 【Results】Three patients had massive hemorrhage during ESD. One was treated with a titanium clip, and the other two cases were managed surgically（resection of antrum）. One of the patients had delayed bleeding 7 days after ESD, which was ceased by suture and ligation through anus. Intestinal perforation happened in another case, who was subjected to intestinal repair. The average postoperative hospital days were 5,Patients were discharged without sequela and no recurrence was observed in 2-27 months follow-up visit. 【Conclusion】ESD is an efficacious and safe procedure for the treatment of gastrointestinal tract diseases. It is possible to completely resect lesions and provide sufficient pathological information. However, ESD is time consuming and technically difficult, usually results in more complications than EMR.