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目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在食管肿瘤治疗中的价值。方法利用染色内镜及超声内镜探测病变范围及侵犯深度,对位于黏膜层及黏膜肌层的早期癌、癌前病变、黏膜下肿瘤等病变行ESD治疗。于病灶边缘2mm处用氩气刀标记切除范围,于病灶及周围黏膜下注射甘油果糖使病变与固有肌层相分离;沿标记线外侧切开病变周围黏膜;剥离病变下方黏膜下层组织,完整切除病变。结果21例病灶,最大直径均大于2cm,病灶最大者直径5cm。8例早期食管黏膜内癌,5例食管黏膜中、重度异型增生及8例食管平滑肌瘤经ESD一次性完全切除。ESD手术时间30～180min,平均110min;术中少量出血均经电凝止血;术后无迟发性出血发生;1例早期食管癌术中发生穿孔(4.76%),经内镜金属夹封闭、内科保守治疗后痊愈。术后随访1～12个月无复发。结论在超声内镜及色素内镜的指导下,采用内镜黏膜下剥离术治疗食管黏膜内癌、癌前病变及黏膜肌层的肿瘤,是一项安全有效的内镜治疗方法。
Objective To investigate the value of endoscopic submucosal dissection (ESD) in the treatment of esophageal neoplasm. Methods To detect the extent of lesions and the depth of invasion by staining endoscopy and endoscopic ultrasonography, and to treat the early cancer, precancerous lesions and submucosal tumors located in the mucosa and muscularis mucosa. Argon knife at the edge of the lesion 2mm mark the excision range, in the lesion and submucosal injection of glycerol fructose so that lesions separate from the muscularis propria; along the outside of the marker line incision open lesion mucosa; stripped below the lesion submucosa, complete resection Lesions. Results 21 cases of lesions, the maximum diameter of more than 2cm, the largest lesions diameter 5cm. 8 cases of early esophageal mucosal carcinoma, 5 cases of esophageal mucosa, severe dysplasia and 8 cases of esophageal leiomyoma by ESD a one time complete resection. ESD operation time was 30 ~ 180min, an average of 110min; a small amount of intraoperative bleeding were coagulation after hemostasis; no postoperative delayed hemorrhage occurred; 1 case of early esophageal cancer perforation occurred (4.76%), closed by endoscopic metal clips, Medical conservative treatment after healed. Follow-up 1 to 12 months after surgery without recurrence. Conclusion Endoscopic submucosal dissection under the guidance of endoscopic ultrasonography and endoscopic endoscopy is a safe and effective method for endoscopic treatment of esophageal mucosal carcinoma, precancerous lesions and muscularis mucosa.