[1]周平红,姚礼庆*,徐美东,等.内镜黏膜下剥离术治疗消化道黏膜下肿瘤[J].中国微创外科杂志,2007,07(11):1063-1065.
　Zhou Pinghong,Yao Liqing,Xu Meidong,et al.Endoscopic Submucosal Dissection for Submucosal Tumor of the Gastrointestinal Tract[J].Chinese Journal of Minimally Invasive Surgery,2007,07(11):1063-1065.
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内镜黏膜下剥离术治疗消化道黏膜下肿瘤()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年11期
页码:
1063-1065
栏目:
出版日期:
2007-11-20

文章信息/Info

Title:
Endoscopic Submucosal Dissection for Submucosal Tumor of the Gastrointestinal Tract
作者:
周平红; 姚礼庆*; 徐美东; 陈巍峰; 钟芸诗; 马黎丽; 张轶群; 秦新裕
复旦大学附属中山医院普外科复旦大学上海医学院外科学系，上海200032
Author(s):
Zhou Pinghong;  Yao Liqing;  Xu Meidong;  et al.
Department of General Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
关键词:
内镜黏膜下剥离术; 内镜外科手术; 黏膜下肿瘤; 消化道
Keywords:
Endoscopic submucosal dissection (ESD);  Endoscopic surgical procedure;  Submucosal tumor (SMT);  Gastrointestinal tract
分类号:
R735
文献标志码:
A
摘要:
目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗消化道黏膜下肿瘤（submucosal tumor，SMT）的疗效和安全性。 方法对内镜发现的19例消化道SMT（食管6例，胃6例，十二指肠1例，乙状结肠1例，直肠5例）进行超声内镜检查（18例病变位于黏膜下层，1例位于固有肌层），应用头端弯曲的针形切开刀进行ESD治疗。黏膜下注射生理盐水抬高病变，使病变与肌层相分离，预切开病变周围黏膜，剥离病变下方黏膜下层结缔组织，完整切除病变。结果病变最大直径0.5～3.0 cm（平均1.6 cm）。18例成功完成ESD治疗，手术时间15～105 min（平均45 min）。2例ESD术中出现内镜难以控制的大出血，1例成功保守治疗（三腔管食管囊压迫），1例转开腹手术。无术后出血。ESD穿孔3例：2例术中消化道穿孔（十二指肠球部和胃底），应用金属夹缝合成功，未转开腹手术；1例直肠类癌剥离深至肌层，术后出现皮下气肿，保守治疗气肿减退。所有ESD剥离病变包膜完整，基底和切缘未见病变累及。结论ESD治疗消化道SMT安全、有效，可以完整切除消化道黏膜下层病变，提供完整的病理诊断资料。对于来源于固有肌层的SMT，应慎行ESD。
Abstract:
ObjectiveTo assess the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for submucosal tumor (SMT) of the gastrointestinal (GI) tract.MethodsA total of 19 patients with SMT of the GI tract diagnosed by endoscopy (6 in the esophagus, 6 the stomach, 1 the duodenum, 1 the sigmoid, and 5 the rectum), were examined using endoscopic ultrasonography (EUS). Among the cases, 18 lesions were within the submucosa and 1 in the muscularis propria. The SMTs were managed by ESD with a needle knife. After injection of physiological saline solution into the submucosal layer to separate the lesion from the muscle layer, the mucosa surrounding the lesion was precut, and the connective tissues of the submucosa beneath the lesion were dissected. Then, the lesion was resected completely.ResultsThe resected lesions sized 0.5-3.0 cm in diameter (mean, 16 cm). Among the 19 lesions, 18 were successfully resected with ESD. The mean ESD procedure time was 45 min (ranged from 15 to 105 min). Two patients had massive hemorrhage during ESD, which could not be controlled under a gastroscope. One of them was treated with balloon compression, and the other was managed surgically. None of the patients had delayed bleeding after ESD. Perforation of the GI tract occurred in 2 cases (the duodenal ball in one, and the gastric fundus in another) during the procedure, and was closed with endoclips without surgical treatment. One patient with rectal carcinoid developed subcutaneous emphysema after the operation owning to deep tearing of the muscle layer, and recovered after several days’ conservative treatment. Histological evaluation showed that the tunica of the tumors was intact, and both the lateral and basal margins of the specimens were free of tumor cells.ConclusionsESD is an efficacious and safe procedure for the treatment of SMT of the GI tract.It is possible to completely resect submucosal lesions and provide sufficient pathological information. For the SMT originated from the muscularis propria, ESD should be performed cautiously.

参考文献/References:

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备注/Memo

备注/Memo:
*通讯作者
更新日期/Last Update: 2013-12-09