内镜黏膜切除术对胃食管连接部病变的治疗价值

目的评价内镜黏膜切除术治疗胃食管连接部病变的疗效、安全性及应用价值。方法经术前内镜检查及黏膜活检证实后，采用内镜黏膜切除术切除51个胃食管连接部病变，其中低度异型增生39个，高度异型增生12个，病灶直径3～28mm，平均（10．9±4．0）mm。对手术前后病理结果进行对照，定期复查内镜进行随访。结果全组有44个病灶被完全切除，完全切除率为86．3％，手术前后病理结果相符的病灶仅26个（50．1％），其余25个病灶中24个病灶术前活检病理级别偏低。并发症主要是出血，17例占33．3％，均经处理后停止出血，无一例发生穿孔或术后狭窄。51例患者随访中无1例复发或死亡。结论内镜黏膜切除术是治疗胃食管连接部病变安全、有效的方法，是阻断癌前病变和早期癌在体内进展的重要策略。

Endoscopic mucosal resection for lesions at gastroesophageal junction

Objective To evaluate the long-term efficacy and safety of endoscopic mucosal resection (EMR) for lesions at gastroesophageal junction (GEJ). Methods A total of 51 lesions located at GEJ from 51 patients, with an average size of 10. 9±4. 0 mm (3-28 mm), were treated with EMR between November 2005 and March 2009, among which 39 were diagnosed as low grade dysplasia and 12 as high grade dysplasia pathologically after EMR. The histopathologic results were compared between biopsies and EMR samples. All patients were followed up endoscopically. Results Complete resection was achieved in 44 ( 86. 3% ). The histopathologic diagnosis of 25 cases (49. 9% ) was inconsistent between biopsy and EMR samples, with 24 exhibited higher grade dysplasia after EMR. Main complication during EMR was bleeding in 17 patients ( 33. 3% ), all of which were successfully managed. No perforation or postoperative stenesis occurred. Endoscopic follow-up was carried out in 8 patients for more than 3 years, in 17 for 2-3 years, in 12 for 1-2 years and in 14 for less than 1 year. No death occurred during follow-up. Conclusion EMR can be adquately adopted as an effective treatment for pre-cuncerous lesions at GEJ, which is important in blocking malignant progression of dysplastic lesions.