内镜粘膜下剥离术治疗胃部病变的短期疗效及临床危险因素

发布时间：2018-06-16 15:48

本文选题：内镜粘膜下剥离术 + 胃部病变　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的1.分析内镜粘膜下剥离术(Endoscopic Submucosal Dissection ESD)治疗胃部病变的短期临床疗效。2.研究内镜粘膜下剥离术(ESD)的安全性和并发症的临床危险因素。研究方法:收集自2012年2月至2015年1月大连医科大学附属第一医院接受ESD治疗胃部疾病病例共58例。记录上述病例的术前检查资料,包括病变部位、大小,术前内镜活检病理结果,手术时间,围手术期合并症及术中并发症,术后病理结果,住院时间。统计病变的一次性整块切除率,组织学治愈性切除率、术前与术后病理符合率。应用SPSS统计软件对上述病例资料进行描述以及分析。结果1.所有ESD病例中,完成51例(87.93%),未完成7例:ESD术中抬举征阴性或明显抬举不良(其中1例穿孔,1例大量出血)终止操作5例(8.62%),其中出血和穿孔的病例经术中内镜下止血、缝合及禁食水、胃肠减压、静脉应用药物治疗等处置后治愈,并择期接受外科手术治疗切除病变,记录术后病理结果。另外的2例未完成病例中,1例(1.72%为术中大量活动性出血,内镜下无法彻底止血),1例(1.72%)为术中穿孔,内镜下无法缝合修补。综上,前者5例(71.43%)接受综合保守治疗缓解,后者2例(28.57%)未完成病例中合并出血与穿孔的病例,均行急诊外科手术。提示ESD在治疗胃部病变相对安全,并且大部分并发症经保守治疗后恢复效果较好。2.在完成的51例接受ESD的患者中,一次性整块切除率达到98.04%,组织学治愈性切除率78.43%,切除的病灶大小平均为最长径2.03cm,最宽径为1.45cm,平均手术时间81.03min,平均住院时间6.41天。ESD作为诊治胃部浅表性疾病的新技术,在和传统外科手术、EMR和内镜下活检等的比较中,在适应征、术后恢复等方面均具有其独特的优势。3.胃早癌、间质瘤、凝血功能异常和病灶位于贲门-胃底(均P0.05)为ESD术中出血的独立危险因素。病灶位于贲门-胃底(P0.001)为ESD穿孔的独立危险因素,间质瘤为可能的危险因素。本研究中,未发现其他并发症,如围手术期心脑血管意外,肺炎及下肢静脉血栓等。结论ESD是一项具有相对较高整块切除率和组织学治愈性切除率的技术,具有创伤小、恢复快、住院天数短等优点。不仅可以一次手术操作可做到多处病变的切除,而且同一患者可接受多次ESD治疗。出血、穿孔等并发症的发生率也相对较低,且大多数可经内镜下操作和综合保守治疗治愈。凝血功能异常、病灶位于贲门-胃底部以及早期胃癌、间质瘤是其术中出血的独立危险因素,病灶位于贲门-胃底是术中穿孔的独立危险因素。严格把握ESD的手术适应征,并且关注其危险因素的情况下,ESD是胃部粘膜和粘膜下病变的安全、可靠的治疗方法。
[Abstract]:Objective 1. Objective to analyze the short-term clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastric lesions. To study the safety and clinical risk factors of endoscopic submucosal dissection (ESD). Methods: from February 2012 to January 2015, 58 cases of gastric diseases were treated with ESD in the first affiliated Hospital of Dalian Medical University. The preoperative examination data were recorded, including lesion location, size, pathological results of preoperative endoscopic biopsy, operative time, perioperative complications, postoperative pathological results and hospitalization time. The rate of one piece resection, the rate of histologically cured resection, and the rate of preoperative and postoperative pathology were calculated. The data of above cases were described and analyzed by SPSS software. Result 1. Of all the ESD cases, 51 completed 87.93s, and 7 failed to complete the termination of the operation (1 perforation and 1 massive hemorrhage) in which 7 cases were negative or significantly poor in lifting during the operation. The bleeding and perforation cases were hemostasis under endoscope during the operation. Suture and fasting water, gastrointestinal decompression, intravenous drug therapy were cured, and surgical treatment was performed to remove the lesions. The pathological results were recorded. In the other 2 cases, 1 case (1.72%) was found to have massive active bleeding during operation, and 1 case was unable to stop bleeding completely under endoscope (1 case) was perforated during operation, and there was no suture and repair under endoscope. In conclusion, the former 5 cases (71.43) were treated with comprehensive conservative treatment and the latter 2 cases (28.57%) with hemorrhage and perforation were all performed emergency surgery. The results suggest that ESD is relatively safe in the treatment of gastric lesions, and the recovery of most complications after conservative treatment is better. 2. 2. Of the 51 patients who received ESD, The resection rate was 98.04, the resectability rate of histologic cure was 78.43. The average diameter of lesion was 2.03 cm, the widest diameter was 1.45 cm, the average operation time was 81.03 min, the average hospitalization time was 6.41 days. ESD was a new technique for the diagnosis and treatment of superficial gastric diseases. Compared with conventional surgical procedures, EMR and endoscopic biopsy have their unique advantages in adaptation and postoperative recovery. Early gastric carcinoma, stromal tumor, abnormal coagulation function and lesion located in cardia-gastric fundus (P0.05) were independent risk factors for bleeding during ESD. P0.001) was an independent risk factor for ESD perforation and stromal tumor was a possible risk factor. In this study, no other complications were found, such as perioperative cardio-cerebrovascular accidents, pneumonia, and venous thrombosis of the lower extremities. Conclusion ESD is a technique with relatively high mass resection rate and histological curable resection rate, which has the advantages of less trauma, faster recovery and shorter hospital stay. Not only can multiple lesions be resected in one operation, but also the same patient can be treated with multiple ESD. The incidence of bleeding, perforation and other complications is relatively low, and most of them can be cured by endoscopic operation and comprehensive conservative treatment. Abnormal coagulation function, the lesion located in the cardia-stomach fundus and early gastric cancer, stromal tumor is the independent risk factor of intraoperative hemorrhage, the focus located in the cardia-stomach fundus is the independent risk factor of intraoperative perforation. ESD is a safe and reliable treatment for gastric mucosal and submucosal lesions.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

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