| 陆启峰,王双平,代子艳,陈保刚,周亚柏,柏婷婷.内镜黏膜下剥离术和挖除术治疗上消化道肿瘤的疗效及安全性分析[J].,2019,19(17):3356-3360 |
| 内镜黏膜下剥离术和挖除术治疗上消化道肿瘤的疗效及安全性分析 |
| Efficacy and Safety of Upper Gastrointestinal Tumor Treated by Endoscopic Submucosal Dissection and Endoscopic Submucosal Excavation |
| 投稿时间：2019-04-05 修订日期：2019-04-30 |
| DOI：10.13241/j.cnki.pmb.2019.17.033 |
| 中文关键词: 内镜黏膜下剥离术 内镜黏膜下挖除术 上消化道肿瘤 危险因素 |
| 英文关键词: Endoscopic submucosal dissection Endoscopic submucosal excavation Upper gastrointestinal tumor Risk factors |
| 基金项目:安徽省自然科学基金项目(1508085QH152) |
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| 中文摘要: |
| 摘要 目的：分析内镜黏膜下剥离术（ESD）和黏膜下挖除术（ESE）治疗上消化道肿瘤的疗效及安全性。方法：回顾性分析2017年1月至2019年4月我院消化内科接受ESD或ESE治疗的68例上消化道肿瘤住院患者的临床资料，收集患者基础疾病、手术时间、病变部位大小、整块切除率、并发症等资料，同时采用Logistic回归分析对术中穿孔进行危险因素分析。结果：64例患者完整切除瘤体（94.12%），肿瘤平均直径（16.98±8.29）mm。食管病灶病理类型以高级别上皮内瘤变为主，有15例（22.06%）；胃部病灶分布以胃体、胃底和胃窦居多，分别有18例（26.47%）、16例（23.53%）和12例（17.65%），病理类型以间质瘤最多，占36.76%；11例患者发生并发症（16.18%），4例患者出现术后出血（5.88%），经过内镜下止血后好转，8例患术中穿孔（11.76%），均行内镜下尼龙绳联合钛夹行荷包缝合，其中1例患者术中穿孔合并术后迟发性出血；病灶最大直径（≥25 mm，P=0.036）和病灶部位（胃底，P=0.015）是导致ESD或ESE术中穿孔的独立危险因素。结论：ESD和ESE治疗上消化道肿瘤安全有效，但需注意病灶大小和胃底病变，因其是导致术中穿孔的独立危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the efficacy and safety of upper gastrointestinal tumor treated by endoscopic submucosal dissection (ESD) and endoscopic submucosal excavation (ESE). Methods: Clinical data of 68 hospitalized patients with upper gastrointestinal tumor who underwent ESD or ESE in our hospital from January 2017 to April 2019 were collected, such as basic diseases, the size, operation time, complete resection rate and complication. According to the Logistic regression equation analysis, the risk factors for the complications of perforation were analyzed. Results: The tumors of 64 cases (94.12%) of patients were en-bloc resected, and the average tumor size was (16.98±8.29 mm). Pathological results showed that high grade intraepithelial neoplasia was the most, 15 cases (22.06%) in the lesion of esophagus. The top three were gastric body, gastric fundus and gastric antrum in gastric lesions, there were 18 cases (26.47%), 16 cases (23.53%) and 12 cases (17.65%), respectively. Pathological results showed that stromal tumor was the most (36.76%). Complications occurred in 11 cases (16.18%), included 4 cases (5.88%) of delayed bleeding (all of them were treated successfully by endoscopic hemostasis therapy), and 8 patients (11.76%) with perforation (all of them were successfully treated by coagulation hemostasis and hemoclip), including 1 patient with perforation and delayed bleeding. Lesion diameter (≥25 mm, P=0.036) and lesion locating at the gastric fundus (P=0.015) were the independent risk factors for perforation in ESD or ESE. Conclusion: ESD and ESE are safe and effective technique for upper gastrointestinal tumor. However, lesion diameter and lesion locating at the gastric fundus should be paid attention as they are the risk factors for perforation. |
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