消化道病变的内镜黏膜下剥离术（ESD）治疗结果和并发症的回顾性研究

发布时间：2018-01-12 17:16

本文关键词：消化道病变的内镜黏膜下剥离术（ESD）治疗结果和并发症的回顾性研究　出处：《东南大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景：内镜黏膜下剥离术是一个在内镜下进行胃肠道病变整块切除的微创手术方式,然而,取得良好的ESD治疗效果则需要一位具有丰富经验和娴熟技能的医师进行操作。目的：本研究通过研究胃肠道不同大小、位置、病理类型的病变ESD术后并发症发生率和复发率来评估ESD治疗效果。并通过病理组织学检查对切除病变的水平和垂直边缘病变残留率进行评估。研究方法：回顾性研究,东南大学附属中大医院2010年5月至2015年3月179例患者ESD术病例资料,对上述患者ESD术后的并发症、病变复发和通过病理组织学检查对切除病变的水平和垂直边缘病变残留率进行数据统计,并对统计资料通过SPSS软件进行t检验及卡方检验进行分析。结果：收集的179例患者中,共有男性93例,女性86例。上述患者ESD术后并发症发生率、复发率、以及病理组织学检查标本水平和垂直病变残留率均较低(分别为8.9%、5%、11.2%)。研究发现任何并发症出现率、病变复发率和病理检查发现切除标本水平和垂直边缘病变残留率与性别和病变的大小无关(P0.05)。不同类型病变(息肉、早癌、癌、良性肿瘤和其他类型病变)的并发症发生率无显著统计学意义(P=0.103)。不同类型病变经ESD切除后,手术标本水平和垂直边缘发现病变残留率无明显统计意义(P=0.223)。然而,不同类型病变的复发率差异具有显著统计学意义(P=0.023)。病变复发多见于通过ESD切除的恶性肿瘤3/12；25%,而未见于ESD切除的息肉0/19；0%。结论：1.总的来说,ESD是一个安全、具有良好治疗效果的手术方式,可以用于切除胃肠道不同部位的多种类型病变。2.患者的性别和年龄对ESD疗效无任何影响。3.在切除的标本边缘能找到残留组织,这可能是切除部位能见度有限以及操作困难的结果,但是残留组织与病灶的类型、大小、部位的关系并不显著。
[Abstract]:Background: endoscopic submucosal dissection is a minimally invasive surgery, gastrointestinal lesions in endoscopic resection achieved good therapeutic effect however, ESD is required to operate a highly experienced and skilled physicians. Objective: through the study on the gastrointestinal tract of different size, location, pathological types of lesions the ESD incidence rate of postoperative complications and recurrence rate to evaluate the therapeutic effect of ESD. And by histopathological examination of the residual lesion in the horizontal and vertical edge disease rate were evaluated. Methods: retrospective study in Zhongda Hospital Affiliated to Southeast University from May 2010 to March 2015, 179 cases of patients with ESD cases, the ESD of patients with postoperative complications, recurrence and the histopathologic examination of the lesions in the horizontal and vertical edges of residual lesion rate for statistical data, and the statistical data. T test SPSS software and chi square test were analyzed. Results: 179 patients were collected, there were 93 cases of male and female 86 cases. The patients with ESD postoperative complication rate, recurrence rate, and histopathological examination of the specimens of horizontal and vertical residual lesion rate was lower (respectively 8.9%, 5%, 11.2%). The study found that any complication rate, recurrence rate and pathological examination found specimens of horizontal and vertical edges of residual disease and gender and lesion size independent (P0.05). Different types of lesions (polyps, early cancer, cancer, benign tumor and other types of lesions) the incidence of complications was not statistically significant. (P=0.103). Different types of lesions after ESD resection, surgical specimens of horizontal and vertical edges found in residual lesion rate has no obvious statistical significance (P=0.223). However, different types of disease recurrence rate difference was statistically significant (P=0.0 23). Recurrence in malignant tumor resection by 3/12 ESD; 25%, but not in ESD 0/19 0%. resection of polyps; conclusion: 1. in general, ESD is a safe surgical method has good treatment effect, can be used for removal of gender and age in different parts of the various types of gastrointestinal lesions in patients with.2. the effect of ESD without any effect of.3. can find residual tissue in the specimen edge cutting, which may be excised and the operation of limited visibility difficult results, but the residue type, and the size of the lesion, parts of the relationship is not significant.

【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R57

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