CAJ | 학술논문

目的：了解上消化道黏膜病变的分布,评价内镜黏膜下剥离术(ESD)治疗上消化道黏膜病变及黏膜下肿物的安全性及疗效；评价超声内镜(EUS)和CO2灌注系统在ESD中的价值。方法166例上消化道黏膜病变及黏膜下肿物患者行ESD,统计一次性病灶完整切除率,观察术中穿孔及术后出血、食管狭窄的发生情况,通过随访评价病灶组织学治愈率。结果166例病例中,食管28例(占16.9%),贲门5例(占3.0%)；胃底19例(占11.4%),胃体17例(占10.2%),胃角14例(占8.4%),胃窦部83例(占50.0%)。术中穿孔4例(占2.4%),术中出血2例(占1.2%),发生延迟后出血1例(占0.6%),一次性完整切除标本145例(占87.3%),病灶组织学治愈率86.1%(143例)。结论ESD治疗上消化道黏膜病变及黏膜下肿物有较好的疗效和安全性。EUS能够为上消化道病变的临床治疗提供依据；在上消化道黏膜病变及黏膜下肿物ESD中, CO2气体灌注系统可减少临床症状及术中、术后并发症。
목적：료해상소화도점막병변적분포,평개내경점막하박리술(ESD)치료상소화도점막병변급점막하종물적안전성급료효；평개초성내경(EUS)화CO2관주계통재ESD중적개치。방법166례상소화도점막병변급점막하종물환자행ESD,통계일차성병조완정절제솔,관찰술중천공급술후출혈、식관협착적발생정황,통과수방평개병조조직학치유솔。결과166례병례중,식관28례(점16.9%),분문5례(점3.0%)；위저19례(점11.4%),위체17례(점10.2%),위각14례(점8.4%),위두부83례(점50.0%)。술중천공4례(점2.4%),술중출혈2례(점1.2%),발생연지후출혈1례(점0.6%),일차성완정절제표본145례(점87.3%),병조조직학치유솔86.1%(143례)。결론ESD치료상소화도점막병변급점막하종물유교호적료효화안전성。EUS능구위상소화도병변적림상치료제공의거；재상소화도점막병변급점막하종물ESD중, CO2기체관주계통가감소림상증상급술중、술후병발증。
Objective To research the distribution of upper gastrointestinal lesions. To evaluate the safety and effect of endoscopic submucosal dissection (ESD) in the treatment of upper gastrointestinal mucosa lesions and submucosal neoplasm. To evaluate the value of Endoscopic ultrasonography (EUS) and CO2 insufflations in endoscopic submucosal dissection (ESD).Methods The complete lesion resection rate of 166 cases with the complete lesion resection rate was summarized. The intraoperative perforation and postoperative esophageal stenosis and delayed hemorrhage were observed. The patients were followed up for evaluation of the histological cure rate.Results Among the 166 cases, there were 28 cases of esophagus (16.9%), 5 cases of cardia (3.0%), 19 cases of fundus of stomach (11.4%), 17 cases of gastric body (10.2%), 14 cases of the angle of stomach (8.4%) and 83 cases of the antrum of stomach (50.0%). There were 4 cases of intraoperative perforation (2.4%), 2 cases of intraoperative bleeding (1.2%), 1 case of delayed bleeding (0.6%) and 145 cases of disposable complete resection (87.3%). Histological cure rate was 86.1% (143 cases).Conclusion ESD is an effective and safety treatment of upper gastrointestinal mucosa lesions and submucosal neoplasm. EUS can provide evidence for the clinical treatment of upper gastrointestinal lesions. CO2 insufflations can reduce clinical symptoms, intraoperative and postoperative complications in ESD of upper gastrointestinal mucosa lesions and submucosal neoplasm.