CAJ | 학술논문

目的：探讨内镜黏膜下剥离术（ ESD）治疗消化道早期癌及癌前病变的护理方法。方法：对45例消化道早期癌及癌前病变患者行ESD治疗，进行ESD前经内镜、染色内镜、超声内镜及组织病理等确诊为（ T1期）肿瘤或癌前病变（如腺瘤，炎性息肉，低-高级别内瘤变），经B超、增强CT或MRI检查未见重要脏器转移灶。术前给予心理护理、术前评估及检查、饮食护理及用药护理，注重术中、术后护理及严密观察相关并发症发生情况，并及时处理。结果：本组完成ESD 43例，成功率95．6％；术中发生出血3例，术后24～72 h迟发性出血2例，均经内镜下止血好转；发生胃、直肠穿孔各1例，通过金属夹夹闭穿孔和术后禁食、胃肠减压等保守治疗后痊愈。32例患者2个月后内镜随访创面愈合，11例患者3～6个月内镜随访均未见局部病灶残留或复发。结论：ESD治疗消化道早期癌及癌前病变具有微创、安全、住院时间短等优点，围术期精心护理是治疗取得成功的重要保证。
목적：탐토내경점막하박리술（ ESD）치료소화도조기암급암전병변적호리방법。방법：대45례소화도조기암급암전병변환자행ESD치료，진행ESD전경내경、염색내경、초성내경급조직병리등학진위（ T1기）종류혹암전병변（여선류，염성식육，저-고급별내류변），경B초、증강CT혹MRI검사미견중요장기전이조。술전급여심리호리、술전평고급검사、음식호리급용약호리，주중술중、술후호리급엄밀관찰상관병발증발생정황，병급시처리。결과：본조완성ESD 43례，성공솔95．6％；술중발생출혈3례，술후24～72 h지발성출혈2례，균경내경하지혈호전；발생위、직장천공각1례，통과금속협협폐천공화술후금식、위장감압등보수치료후전유。32례환자2개월후내경수방창면유합，11례환자3～6개월내경수방균미견국부병조잔류혹복발。결론：ESD치료소화도조기암급암전병변구유미창、안전、주원시간단등우점，위술기정심호리시치료취득성공적중요보증。
Objective:To explore the nursing methods in the treatment of patients with early gastrointestinal cancer and precancerous le -sions by endoscopic submucosal dissection ( ESD ) .Methods:45 patients with early gastrointestinal cancer and precancerous lesions re-ceived ESD .Before the treatment ,the patients were diagnosed of ( T1 ) cancer or precancerous lesions by the examination of endoscopy , chromoendoscopy ,endoscopic ultrasonography and pathology confirmation ( such as adenomas ,inflammatory polyp ,low and high-grade in-traepithelial neoplasia ) ,but the metastasis of main organs was not found by the examination of type B ultrasound , enhanced CT scan or MRI.The patients were given preoperative psychological care ,preoperative evaluation and examination ,dietary care and medication ,the in-traoperative and postoperative nursing care and close observation of related complications were paid much attention to .Results:43 patients were treated by ESD and the success rate was 95.6%;intraoperative hemorrhage occurred in 3 patients;the delayed hemorrhage in 24 ~72 hours after operation occurred in 2 patients and all patients were treated by endoscopic hemostasis;the gastric and rectal perforation oc-curred in one patient and the patient was cured by conservative treatment .32 patients were examined by endoscopy 2 months later and the surface of wound of these patients was found healed;local residual lesions and recurrence was not found in 11 patients examined by endos-copy 3 ~6 months later .Conclusion:ESD applied to the treatment of early gastrointestinal cancer and precancerous lesions has the advan -tages of minimal wound ,safety and short hospitalization .The careful perioperative nursing care is an important guarantee for the success of the treatment.