重视并开展内镜黏膜下剥离术的规范化操作

内镜切除术治疗胃肠道早期肿瘤正日益被接受并开展应用,包括传统的内镜黏膜切除术（EMR）和近年开展的内镜黏膜下剥离术（ESD）。EMR对于15mm以上的病灶较难做到一次切除,而整块切除标本对病理学评估至关重要,ESD正是应这一要求开展起来的新技术。对局限于黏膜层的病变,ESD并不受其大小的限制,对部分早期胃肠道肿瘤,其可取代传统的手术治疗,但ESD需要相当高的内镜操作技术,术前需要多种方法对病灶进行谨慎、全面的评估,包括范围、浸润深度等,术中、术后还可能出现出血、穿孔等严重的并发症,其发生率远高于EMR。ESD的指征、操作技巧、病理评估等方面还需要不断完善。由于ESD在早期胃肠道肿瘤的治疗上具有很多优点,值得有条件医院的内镜医师予以重视并开展这一技术。

Emphasizing and Performing the Standardized Procedure of Endoscopic Submucosal Dissection

Endoscopic resection of early gastrointestinal cancer,including endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD）,has been increasingly accepted and used. The evidence suggests that lesions larger than 15 mm cannot be resected in one piece using the EMR technique. However,specimen of en bloc resection is critically important for pathological evaluation. ESD is a new endoscopic technique developed on this demand. For localized intramucosal lesion,ESD is not limited by the size of lesion,and is expected to replace conventional surgical operation in a certain proportion of early gastrointestinal cancer. However,it requires higher level of endoscopic skill and cautious and full pre-operative evaluation of the lesions including extent of lesion and infiltrating depth,and may associate with a higher incidence of severe complications,such as bleeding and perforation peri-and post-operatively. Indication,technique,and pathological assessment of ESD need to be further improved and perfected. Because ESD has many merits in the management of early gastrointestinal cancer,it is worth for endoscopists in hospitals with proper facilities to emphasize and perform this technique.