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目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)处理消化道病灶的实用性及安全性。方法对7例消化道早期癌肿及18例深度未超过黏膜下层的黏膜下肿瘤共25例行ESD治疗。结果 25例患者均一次性完整切除病灶。所有治疗中均伴有术中出血,用ESD专用热止血钳、APC、金属止血夹成功止血,未发生术后迟发出血。术中穿孔1例,穿孔率为4%(1/25),以金属夹成功夹闭,无术后迟发穿孔。术后随访20例(包括7例消化道早期癌肿及13例黏膜下肿瘤),随访期为7～17个月(平均12.2个月),随访创面均完全愈合,未见复发病灶。结论ESD作为一种微创治疗方法,对于浸润深度不超过黏膜下层的病灶可以一次性大块剥离,从而获得完整的病理学诊断资料,安全性较好。但操作过程复杂,技术难度高。
Objective To investigate the practicability and safety of endoscopic submucosal dissection (ESD) in the treatment of digestive tract lesions. Methods Seven patients with early gastrointestinal cancer and 18 patients with submucosal depth less than submucosal tumors were treated with ESD. Results All the 25 patients underwent a complete resection of the lesion. All treatments were accompanied by intraoperative bleeding, with ESD-specific thermal hemostat, APC, metal hemostatic clip to stop bleeding, delayed bleeding occurred after surgery. Perforation in 1 case, the perforation rate was 4% (1/25), with a metal clip successfully closed, no postoperative delayed perforation. All cases were followed up for 20 cases (including 7 cases of early digestive tract cancer and 13 cases of submucosal tumor). The follow-up period was 7 to 17 months (average 12.2 months). All wounds healed completely and no recurrence was found. Conclusion As a minimally invasive treatment, ESD can remove the lesion which does not exceed the depth of submucosa once and for all, thus obtaining a complete pathological diagnosis data with better safety. However, the operation is complicated and the technical difficulty is high.