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[目的]探讨内镜黏膜下剥离术(ESD)切除消化道平坦型及黏膜下肿瘤的疗效及安全性。[方法]内镜下诊断的黏膜平坦型病变和黏膜下肿物8例均使用Hook刀行ESD切除:(1)黏膜病变常规染色,黏膜下病变用活检钳推之有活动感。(2)在病变边缘做标志。(3)黏膜下注射使病变和固有肌层分离。(4)预切开病变周围黏膜。(5)剥离病变下方结缔组织,完整切除病灶。[结果]Barrett’s食管2例,胃平滑肌瘤1例,直肠侧向发育型肿瘤,病理报为管状-绒毛状腺瘤1例,乙状结肠侧向发育型肿瘤、病理报为管状-绒毛状腺瘤并中-重度非典型增生1例,直径类癌1例,直肠黏膜下平滑肌瘤2例。所有病变均得到病理证实。病变直径1.5～2.5cm。所有平坦型黏膜病变基底及边缘完整,黏膜下病变包膜完整。7例成功切除,1例穿孔转开腹手术。[结论]内镜黏膜下剥离术切除消化道黏膜平坦型病变及黏膜下肿瘤可行、有效,切除病灶完整,但要开展黏膜下剥离术(ESD)应非常慎重。
[Objective] To investigate the efficacy and safety of endoscopic submucosal dissection (ESD) for the resection of flat and submucosal tumors of the digestive tract. [Methods] 8 cases of mucosal flat lesions and submucosal tumors diagnosed by endoscopy were treated with Hook knife ESD (1) mucosal lesions routine staining, submucosal lesions with biopsy forceps push activities. (2) mark on the edge of the lesion. (3) submucosal injection of the lesion and the inherent myometrial separation. (4) precut lesions around the mucosa. (5) stripping the connective tissue below the lesion, complete removal of the lesion. [Results] Two cases of Barrett’s esophagus, one case of gastric leiomyoma and one case of rectal lateral developmental tumor were pathologically reported as tubular-villous adenoma, sigmoid colon lateral developmental tumor, pathological report was tubular-villous adenoma 1 case of moderate-severe atypical hyperplasia, 1 case of diameter carcinoid and 2 cases of rectal mucosal leiomyoma. All lesions were confirmed by pathology. Lesions diameter 1.5 ~ 2.5cm. All flat mucosal lesions and the integrity of the basal, submucosal lesions complete capsule. Seven cases were successfully resected and one case was perforation to open laparotomy. [Conclusion] Endoscopic submucosal dissection resection of gastrointestinal mucosa flat lesions and submucosal tumors feasible and effective, complete removal of the lesion, but to carry out submucosal dissection (ESD) should be very careful.