内镜黏膜下剥离术治疗胃食管连接部癌前病变的临床效果观察.docVIP

内镜黏膜下剥离术治疗胃食管连接部癌前病变的临床效果观察 　　[摘要] 目的 观察内镜黏膜下剥离术（ESD）治疗胃食管连接部（GEJ）癌前病变的临床疗效。 方法 选取本院2008年5月～2012年7月收治的72例GEJ癌前病变患者作为研究对象，均给予ESD治疗，统计手术成功率、手术时间、出血量、手术切除面积、病理类型及穿孔、出血等并发症发生率，术后随访12个月，观察治疗效果。 结果 本组70例患者成功接受ESD，手术成功率为97.2%。平均手术时间为（72.3±10.4）min，平均术中出血量为（15±4.5）ml。术后发热2例，给予抗感染治疗后治愈；未见出血和穿孔等并发症。手术平均切除面积（18.5±21.3）mm2。病理学检查平滑肌瘤29例，原位癌15例，黏膜鳞状上皮增生5例，低度恶性间质瘤12例，胃息肉7例，胃纤维瘤4例。随访68例，失访率（5.56%）。随访期间复发3例，复发率为4.17%；平均复发时间（7.5±3.4）个月；复发病灶面积平均（12.2±4.7）mm2。3例复发患者均给予内镜下切除，再次手术后随访12个月未再复发。 结论 ESD治疗GEJ癌前病变疗效确切，其手术切除率高，创伤小，并发症少，术后恢复快，复发率低，是当前临床治疗GEJ癌前病变的首选方法。 　　[关键词] 内镜黏膜下剥离术；胃食管连接部癌前病变；疗效 　　[中图分类号] R57 [文献标识码] A [文章编号] 1674-4721（2013）07（a）-0047-02 　　Clinical effect observation of endoscopic submucosal dissection for patients with precancerous lesions of gastroesophageal junction 　　YANG Yu-yu 　　Department of Digestion Medicine， Peoples Hospital of Zhongshan City in Guangdong Province， Zhongshan 528400，China 　　[Abstract] Objective To observe the clinical effectiveness of endoscopic submucosal dissection （ESD） for patients with precancerous lesions of gastroesophageal junction （GEJ）. Methods Seventy two patients with precancerous lesions of GEJ admitted to our hospital from May 2008 to July 2012 were selected as study objects. All patients were treated by ESD. The surgical success rate， operative time， amount of blood loss， the area of surgical resection， pathological type， occurrence rate of complication such as perforation and bleeding were statistically analyzed. The therapeutic effect was observed by postoperative follow up of 12 months. Results In this study， 70 patients underwent successful ESD with surgical success rate of 97.2%， average operative time of （72.3±10.4） min， average amount of blood loss of （15±4.5） mL during operation. There were 2 cases of postoperative fever cured with anti-infective therapy； no complication such as bleeding and perforation. The average area of surgical resection was （18.5±21.3） mm2. The pathological examination found 29 cases of leiomyom