CAJ | 학술논문

目的：探讨内镜黏膜下剥离术（endoscopic submucosal dissection ，ESD）完整切除消化道黏膜下肿瘤（submucosal tumor，SMT）的可靠性及安全性。方法43例 SMT 患者行 ESD，统计病灶一次性完整切除率，观察术中穿孔及术后出血情况，评价病灶组织学治愈率。结果43例患者中，29例（67．44％）一次完整剥离成功，14例改用腹腔镜完整切除病灶。术中穿孔11例（25．58％），包括1例胃粘膜下层颗粒细胞瘤，10例固有肌层来源的间质瘤。10例行胃壁全层切除，1例剥离病变后采用APC 处理创面时发生穿孔。3例因内镜下创面封闭困难行腹腔镜修补术，8例经胃镜下金属夹成功缝合创面。33例术后随访1～3年，均未复发。结论ESD 技术的发展使深层消化道 SMT 的内镜完整切除成为可能，并可提供完整的病理诊断，其创伤小、恢复快、并发症发生率低，能维持正常生理解剖结构，可使该类患者免于剖腹手术。
목적：탐토내경점막하박리술（endoscopic submucosal dissection ，ESD）완정절제소화도점막하종류（submucosal tumor，SMT）적가고성급안전성。방법43례 SMT 환자행 ESD，통계병조일차성완정절제솔，관찰술중천공급술후출혈정황，평개병조조직학치유솔。결과43례환자중，29례（67．44％）일차완정박리성공，14례개용복강경완정절제병조。술중천공11례（25．58％），포괄1례위점막하층과립세포류，10례고유기층래원적간질류。10례행위벽전층절제，1례박리병변후채용APC 처리창면시발생천공。3례인내경하창면봉폐곤난행복강경수보술，8례경위경하금속협성공봉합창면。33례술후수방1～3년，균미복발。결론ESD 기술적발전사심층소화도 SMT 적내경완정절제성위가능，병가제공완정적병리진단，기창상소、회복쾌、병발증발생솔저，능유지정상생리해부결구，가사해류환자면우부복수술。
Objective To evaluate the safety and reliability of endoscopic submucosal dissection (ESD)for complete resection of gastrointestinal submucosal tumors(SMT).Methods Forty-three patients with SMT underwent ESD .The complete resection rate,in-traoperative perforation and delayed hemorrhage were statistically analyzed .The patients were followed up for evaluation of the histologi -cal cure rate.Results Of the 43 patients,29 SMT were completely resected (67.44%),and 14 cases were transferred into laparoscopic resection.Intraoperative perforation happened in 11 patients(25.58%) including 1 case with gastric submucosal granulosa cell tumor and 10 cases with interstitialoma in muscularis propria layer .Of those perforations,10 cases were resulted from planed endoscopic full -thickness resection and 1 was due to APC treatment.Except for 3 cases transferred to laparoscopic closing ,others were successfully closed under endoscopy followed by gastrointestinal decompression and antibiotics treatment .Thirty-three patients were followed -up for 1 to 3 years and no recurrence was found .Conclusion ESD is an effective and safe treatment of gastrointestinal submucosal tumors .This technique is able to resect the deep gastrointestinal lesions and provide precise pathological information about the lesion .The minimal invasiveness,rapid recovery time and low complication rate of this technique provide another choice for SMT patients to avoid from inva -sive surgery.