内镜黏膜下剥离术治疗胃黏膜浅表病变的疗效和并发症分析

发布时间：2018-03-27 06:21

本文选题：胃黏膜病变　切入点：内镜　出处：《第二军医大学学报》2017年12期

【摘要】：目的探讨内镜黏膜下剥离术(ESD)治疗胃黏膜浅表病变的临床安全性和效果,并对ESD治疗出现并发症的相关因素及处理进行分析。方法回顾性分析116例胃黏膜浅表病变行ESD治疗患者的临床病例资料,观察ESD的治疗情况和效果,分析术中及术后出现并发症的相关因素及处理情况。结果 116例胃黏膜浅表病变全部完成ESD治疗,一次性整块切除率为99.1%(115/116),组织学完全治愈性切除率为95.7%(111/116),肿瘤平均最大径为(25.0±11.6)mm,平均手术时间(56.6±20.5)min;术中急性少量出血发生率为3.4%(4/116),无急性大量出血发生,延迟性出血发生率为0.9%(1/116);5例出血病例均应用电凝止血和止血夹联合内镜下止血成功;术中穿孔发生率为2.6%(3/116),3例穿孔病例在术中应用钛夹夹闭,穿孔患者无气腹发生,均保守治疗成功。ESD术后2个月时复查,创面溃疡愈合率为100%,术后平均随访(20.3±5.1)个月。术中出血和穿孔发生的危险因素为胃角(χ~2=7.937,P=0.01)及术后病理结果为早期胃癌(χ~2=9.145,P=0.005)。结论 ESD是一种安全有效的胃黏膜浅表病变微创治疗方法,手术操作成功率高;强调ESD术中和术后应注意预防性止血。强调早期术中发现穿孔,大多能完成内镜下穿孔的有效闭合。
[Abstract]:Objective to investigate the clinical safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of superficial gastric mucosal lesions. Methods the clinical data of 116 patients with superficial gastric mucosal lesions treated with ESD were analyzed retrospectively, and the therapeutic effects of ESD were observed. Results all 116 cases of superficial lesions of gastric mucosa were treated with ESD. The resection rate of one piece was 99.1 / 115 / 116%, the rate of histologically completely cured resection was 95.771% / 116%, the mean maximum diameter of tumor was 25.0 卤11.6mm, the mean operation time was 56.6 卤20.5min, the incidence of acute small amount of hemorrhage was 3.4% / 116t, and there was no acute massive hemorrhage. The incidence of delayed hemorrhage was 0.9 / 116% and 5 cases of bleeding were treated with electrocoagulation hemostasis and hemostatic clip combined with endoscopic hemostasis, and the incidence of perforation during operation was 2.6% 3 / 116%, 3 cases of perforation were treated with titanium clamp during operation, and no pneumoperitoneum occurred in the perforation patients, and no pneumoperitoneum was found in the patients with perforation. All the patients were reexamined 2 months after the successful treatment of ESD. The healing rate of wound ulcer was 100 and the average follow-up was 20.3 卤5.1 months. The risk factors of bleeding and perforation during operation were gastric angle (蠂 ~ 2 ~ 2 ~ (7.937) P ~ (0. 01)) and postoperative pathological results were early gastric cancer (蠂 ~ (2) 9. 145 ~ P ~ (0.005)). Conclusion ESD is a safe and effective minimally invasive therapy for superficial gastric mucosal lesions. It was emphasized that preventive hemostasis should be paid attention to during and after ESD, and that the early detection of perforation, most of which could complete the effective closure of endoscopic perforation.
【作者单位】：武汉大学人民医院消化内科;
【分类号】：R573

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