微创医学

目的探讨内镜下黏膜切除术(EMR)诊治上消化道黏膜层病变的临床应用价值。方法选取116例经胃镜检查并经超声内镜(EUS)明确起源于黏膜层的隆起性病变患者,行EMR切除,术后标本送病理检查,并定期门诊内镜随访。结果 116例患者共119处病灶,116处(97.5%)获完全切除,平均随访4.5个月无复发。术后病理为43处息肉、40处平滑肌瘤、15处炎症、9处间质瘤、2处早癌、2处类癌、2处黏膜下囊肿、其他6处,其中28例曾行术前病理活检,14例(50%)术前、术后病理吻合,14例(50%)依靠切除后大体标本送检明确诊断。并发出血20例,均经处理后停止出血,无1例发生穿孔。结论 EMR是治疗上消化道黏膜层病变安全、有效、实用的微创技术,因组织切除、取材完整,可提高病变确诊率。

Objective To evaluate the efficacy of endoscopic mucosal resection ( EMR ) in the diagnosis and therapy of upper gastrointestinal mucosal lesions． Methods The gastrointestinal mucosal protrusive lesions of 116 patients were proved to originate from the mucosa by endoscopy and endoscopy ultrasound( EUS) ． The patients were treated with EMR． The specimens were fixed，labeled and sent to histological examinations． These patients were required on regular endoscopic follow-up review． Results 116 patients had a total of 119 lesions，116 ( 97． 5%) lesions were completely removed，and none of them recurred during an average of 4． 5 months follow-up period． Histological results showed: 43 polyps， 40 leiomyomas，15 inflammation，9 stromal tumors，2 early carcinomas，2 carcinoids，2 submucosal cyst，and 6 cases of other lesions． A total of 28 cases had histological biopsy before the operation，consistent diagnosis rate before and after the procedure was 50% ( n = 14) ， and the other 14 cases ( 50%) had a clear diagnosis relying on larger biopsy after the procedure． Complicated bleeding occurred in 20 cases，but stopped after treatment，and no perforation were observed． Conclusions EMR is a safe，effective，practical and minimally invasive endoscopic technique for removing upper-gastrointesinal lesions within mucosa． EMR may improve the diagnosis rate of lesions since complete and larger tissue are obtained for histological examination．