摘要
目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗消化道良性息肉(腺瘤样或增生性),癌前期病变和早期癌的临床价值。方法收集2012年3月至2013年3月,于中山大学附属汕头医院行ESD术的100例术前活检病理等证实为食管,食管胃结合部,胃,结肠,直肠息肉(腺瘤样或增生性),不典型增生或早期癌变患者的临床资料,评价ESD手术治疗消化道息肉,癌前病变及早期癌的安全性和疗效。结果本组100例患者包括消化道息肉(腺瘤样或增生性)81例,不典型增生15例,早期癌4例,其中男性54例,女性46例,年龄23～87(62±12)岁。直肠病变12例,结肠病变54例,胃病变22例,胃食管结合部病变4例,食管病变8例。病灶直径0.5～4.0cm。所有患者均顺利完成了内镜下切除手术(1例穿孔较大行腹腔镜下修补),手术时间10～110(中位数38)min,出血量0～40(中位数5)mL。其中术中穿孔3例,术中出血4例,术后迟发性出血3例(通过保守治疗痊愈)。100例患者均接受了随访,随访时间1～12个月,有一例复发(低位直肠腺瘤并中度非典型增生,病灶大),后经外科手术治愈,余无复发或转移病例。结论只要掌握合适的病例,ESD治疗消化道息肉(腺瘤样增生性),癌前病变及早期癌具有创伤小,恢复快,并发症少等良好的疗效和安全性,并能提供完整的病理学资料。
Objective To evaluate the clinical value of endoscopic submucosal dissection （ESD） in the therapy of benign gastrointestinal polyps （adenomatous or hyperplastic）, pre-cancerous lesions and early cancer. Methods Clinic datas were collected retrospectively in 100 patients with a preoperative biopsy confirmed the esophagus, esophagugastric junction, stomach, colon, rectum polyps （adenomatous or hyperplasia）, atypical hyperplasia or early cancer, who underwent ESD surgery in Affiliated Shantou Hospital of Zhongshan university from March 2012 to March 2013. Evaluate safety and efficacy of the ESD surgical therapy in gastrointestinal polyps, precancerous lesions and early cancer. Results Of the 100 patients, including 81 cases of gastrointestinal polyps （adenomatous or hyperplastic）, 15 cases of atypical hyperplasia, 4 cases of early cancer. 54 males and 46 females, age range from 23 to 87 （62~12）years. Rectal lesions in 12 cases, 54 cases of colon lesions, 22 cases of gastropathy, 4 cases of the gastroesophageal junction lesions, 8 cases of esophageal lesions. Lesion diameter was 0.5- 4.0era. All patients successfully received endoscopic resection （one case with large perforation received laparoscopic repair）. The operation time was I0-110 （median38） rains, the blood loss was 0--40（median5）mL. Intraoperative perforation in 3 cases, blood loss in 4 cases, 3 cases of delayed bleeding （conservative treatment cured）. 100 patients received follow-up of 1-12 months, one case which get recurrence （low rectal adenoma with moderate atypical hyperplasia） received surgical cure, no other cases of recurrence or metastasis. Conclusion For the appropriate cases, ESD in the treatment of gastrointestinal polyps （adenomatous or hyperplastic）, precancerous lesions and early carcinoma was painless, faster recovery, fewer complications. It was effective, safe and can provide the pathology datas.
出处
《中国医药指南》
2013年第19期58-60,共3页
Guide of China Medicine
关键词
内镜黏膜下剥离术
消化道
癌前病变
息肉
早期癌
Endoscopic submucosal dissection
Gastrointestinal
Benign Polyps
Precancerous lesions
Early Cancer
