CAJ | 학술논문

目的分析内镜黏膜下剥离术( ESD)治疗消化道黏膜浅表性病变的有效性及并发症的危险因素.方法前瞻性观测上海长海医院应用ESD治疗154例消化道浅表性病变的效果以及并发症发生情况,并对后者发生率较高的出血及其相关危险因素进行统计学分析.结果完成ESD的145例中,一次性整块切除率100.0％,其中组织学完全治愈性切除率99.3％；9例因术中出血(5例)或穿孔(4例)未能完成ESD.发生术中大量出血6例(6/154,3.9％),少量出血5例(3.2％),术后延迟出血1例(0.6％),消化道穿孔4例(2.6％),消化道狭窄1例(0.6％),以上均经相应治疗后好转,无死亡病例.术后残留1例,经再次ESD治愈.术后8周复查,溃疡愈合率100％；平均随访10.6(8 ～18)个月,无局部复发.ESD出血并发症的独立危险因素为:病变部位(贲门胃底部),病变面积(随着病变面积增大其危险度提高).结论 ESD是治疗消化道浅表性病变安全、有效的方法,严格掌握手术适应证、个体化治疗,有助于降低并发症发生.
목적 분석내경점막하박리술( ESD)치료소화도점막천표성병변적유효성급병발증적위험인소.방법 전첨성관측상해장해의원응용ESD치료154례소화도천표성병변적효과이급병발증발생정황,병대후자발생솔교고적출혈급기상관위험인소진행통계학분석.결과 완성ESD적145례중,일차성정괴절제솔100.0％,기중조직학완전치유성절제솔99.3％；9례인술중출혈(5례)혹천공(4례)미능완성ESD.발생술중대량출혈6례(6/154,3.9％),소량출혈5례(3.2％),술후연지출혈1례(0.6％),소화도천공4례(2.6％),소화도협착1례(0.6％),이상균경상응치료후호전,무사망병례.술후잔류1례,경재차ESD치유.술후8주복사,궤양유합솔100％；평균수방10.6(8 ～18)개월,무국부복발.ESD출혈병발증적독립위험인소위:병변부위(분문위저부),병변면적(수착병변면적증대기위험도제고).결론 ESD시치료소화도천표성병변안전、유효적방법,엄격장악수술괄응증、개체화치료,유조우강저병발증발생.
Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for digestive tract mucosal lesions,and risk factor of complications.Methods The data of 154 consecutive patients who underwent ESD for superficial digestive tract mucosal lesions were analyzed prospectively for therapeutic effect and rate of complications.Risk factors for bleeding was analyzed.Results The enbloc resection rate in 145 completed ESD procedures was 100.0％.Histologically,complete resection rate was 99.3％.ESD was not completed in 9 patients due to bleeding ( n =5) and perforation ( n =4).Acute massive bleeding occurred in 6 patients (6/154,3.9％),mild bleeding in 5 (3.2％),delayed bleeding in l (0.6％ ),perforation in 4 (2.6％ ) and post-ESD stenosis in 1 (0.6％ ).All complications were cured.The post-ESD ulcer-healing was achieved in 100％ at 8 weeks after treatment.During follow-up of 10.6months( ranged from 8 to 18 months),no residual or local recurrence was found.Statistic analysis showed independent risk factors for bleeding in ESD were lesion location (cardiac fundus),and lesion size.Conclusion ESD is an effective and safe procedure in treatment of digestive tract mucosal lesions.The complications of ESD are preventable and curable.Strictly controlling operation indications,individualized treatment and the proficient operation skills of physicians are the keys to success.