内镜下黏膜切除术及剥离术在早期消化道肿瘤中的应用

目的 探讨内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗消化道黏膜层病变包括癌的疗效和安全性。方法 对行EMR和ESD治疗的215例患者260处消化道病变做回顾性分析。结果 食管病灶4处,胃70处,大肠186处,其中EMR 185例,ESD 30例。ESD病变长径、手术时间均明高于EMR；EMR术后2例迟发性出血,无穿孔,ESD术后1例迟发性出血,术中穿孔2例,皆内镜下钛夹夹闭治疗后治愈。术后病理确诊早期癌变7处,高级别上皮内瘤变28处,腺瘤性息肉伴低级别上皮内瘤变161处,间质瘤6处,炎性息肉及其他58处。术后3个月和6个月行内镜随访,无病变残留和复发。结论 EMR和ESD技术治疗消化道黏膜层病变是安全有效的,可以提供完整的病理诊断学资料。EMR和ESD可用于治疗消化道早期癌变及癌前病变。

Endoscopic mucosal resection and endoscopic submucosal dissection for gastrointestinal elevated lesions

Objective To investigate the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosa1 dissection(ESD)for gastrointestinal mucous layer lesions.Methods A retrospective analysis was made of 215 cases of gastrointestinal elevated lesions treated with EMR and ESD.Results Four lesions were located in esophagus,70 in stomach,186 in colon.185 cases were treated by EMR and 30 by ESD.The length of lesion and operative time of EMR group were significanly lower than the ESD group.Two cases of delayed bleeding and no case of perforation occurred in EMR group while 1 case of delayed bleeding and 2 cases of perforation occurred in ESD group,which were all cured with conservative treatment.Pathological examination indicated 7 cases of early carcinoma,28 cases of high grade intraepithelial neoplasia,161 cases of low grade intraepithelial neoplasia, 6 cases of stromal tumors,and 58 cases of polyps.Both the lateral and basal margins of the specimens were observed without tumor cells.Followed up in 3 and 6 months after operation,al1 cases were confirmed healing of the artificial ulcer with no residue or recurrence.Conclusions EMR and ESD are effective and safe endoscopic surgical procedures for treating gastrointestinal mucous layer lesions.It is possible to completely resect submucosal lesions and provide sufficient pathological information.EMR and ESD can be used to treat early cancer.