内镜黏膜下剥离术风险控制的初步探讨

Preliminary exploratory study on risk controlling of endoscopic submucosal dissection

关键词:  内镜黏膜下剥离术  早期胃肠道肿瘤  并发症

Key words:  endoscopic submucosal dissection  early gastroenteric tumor  complication

摘要:

［目的］通过内镜黏膜下剥离术（ESD）治疗消化道病变,探讨手术风险控制方法。［方法］2008年3月～2010年8月内镜检查发现的消化道病灶病例作为入选对象，共131例。术前行染色内镜和超声内镜检查，确定病变范围和深度，常规行术前评估。手术步骤：（1）应用氩气刀（APC）于病灶边缘标记；（2）于病灶边缘标记点外侧进行多点黏膜下注射；（3）切开病变外侧缘周围黏膜；（4）于病灶黏膜下层进行剥离；（5）创面处理。观察手术时间、黏膜下注射液体量、手术前后血红蛋白水平变化、手术成功率及并发症发生率。［结果］切除标本最大直径平均（3.61±0.99）cm；术中平均黏膜下注射量为（29.2±11.53）mL；平均手术操作时间（68.70±31.69）min；手术完整剥离成功率95.4%；穿孔发生率3.1%。［结论］采取综合措施可有效减少并发症的发生率，有利于并发症的及时处理，有效地控制手术风险。

Abstract:

［Objective］To explore the risk controlling methods of the technique of endoscopic submucosal dissection (ESD).［Methods］One hundred and thirty one patients with lesions of gastrointestinal tract detected by endoscopy were enrolled from March 2008 to August 2010.Chromoendoscopy and endoscopic ultrasonography were applied to confirm the extent and depth of the lesions.All the patients were practiced routine preoperative evaluation.The procedure of ESD was as follows: (1) identified the lesions by argon plasma coagulation (APC); (2) raised the submucosa through submucosal injection; (3) pre-cut the circumferential mucosa of the target lesion; (4) completely dissected along the submucosal layer; (5) to deal with raw surface;then to insert three-lumen gastrojejunaltube in upper gastrointestinal case.The operation time,quantity of submucosal injection solution and change of blood Hb levels between pre- and post-ESD and the En bloc resection rates and complications were also detected. ［Results］The max diameter of resection samples was (3.61±0.99) cm.The quantity of submucosal injection solution was (29.2±11.53) mL.The operation time was (68.70±31.69) min.The En bloc resection rate was 95.4%.The perforation rate was 3.1%.［Conclusion］ESD when practiced with composite measures results in less complication rates,profit deal with complication in time and avoid medical risk effectually.