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目的分析经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)诊治消化道早期癌前病变患者疗效和预后。方法 2013—2016年舟山市妇幼保健院共收治62例疑似消化道癌肿患者,其中,男性41例,女性21例,平均(58.5±6.2)岁。患者均经ESD进行诊断和治疗,术后病理结果确诊为早期癌前病变。考察ESD诊断和治疗的效果,并发症情况和患者的预后。结果病变均在黏膜、黏膜下层,部位分别在食管17例(27.42%)、胃29例(46.77%)、结肠16例(25.81%),其中多为食管中段(10例,58.82%)。病理分型分别为Ⅰ型3例(4.84%)、Ⅱ型59例(95.16%),其中多为Ⅱb(28例,47.16%)。病灶完全切除率为95.16%(59/62),治愈性切除率为90.32%(56/62)。术中出血1例(1.61%),穿孔2例(3.23%),术后胸骨后疼痛2例(3.23%),腹痛1例(1.61%),均经抗感染、抑酸等治疗后痊愈。随访第6个月无失访患者,患者的进食不适、吞咽困难等症状均得到明显地缓解(分别为21例,33.87%和18例,29.03%)。复发1例(1.61%),经再次ESD术后痊愈出院。结论 ESD诊治消化道早期癌前病变的切除率高,并发症和术后复发率较低,可以作为微创诊疗消化道癌前病变的首选手段。
Objective To analyze the efficacy and prognosis of endoscopic submucosal dissection (ESD) in the diagnosis and treatment of gastrointestinal precancerous lesions. METHODS: Totally 62 cases of suspected gastrointestinal cancer patients were treated in Zhoushan MCH from 2013 to 2016. There were 41 males and 21 females, with an average of 58.5 ± 6.2 years. Patients were diagnosed and treated by ESD, postoperative pathological findings were diagnosed as early precancerous lesions. Investigate the effects of ESD diagnosis and treatment, complications, and patient outcomes. Results The lesions were located in the mucosa and submucosa, with 17 cases (27.42%) in the esophagus, 29 cases (46.77%) in the stomach, and 16 cases (25.81%) in the colon. Most of them were esophagus (10 cases, 58.82%). The pathological types were type Ⅰ in 3 cases (4.84%), type Ⅱ in 59 cases (95.16%), mostly Ⅱb (28 cases, 47.16%). The complete resection rate was 95.16% (59/62), and the curative resection rate was 90.32% (56/62). Intraoperative bleeding in 1 case (1.61%), perforation in 2 cases (3.23%), postoperative sternal pain in 2 cases (3.23%) and abdominal pain in 1 case (1.61%) were cured by anti-infection and acid suppression. No patient lost to follow-up at the 6th month of follow-up, symptoms such as discomfort and dysphagia were significantly relieved (21 cases, 33.87% and 18 cases, 29.03%, respectively). One patient (1.61%) relapsed, and was discharged after ESD again. Conclusion ESD diagnosis and treatment of digestive tract early precancerous lesions removal rate, complications and postoperative recurrence rate is low, can be used as minimally invasive treatment of gastrointestinal precancerous lesions of choice.