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[目的]评估内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗消化道早癌及癌前病变的疗效及安全性。[方法]回顾性分析行ESD治疗的125例消化道早癌及癌前病变的患者的手术成功率、安全性、并发症及预后等。[结果]125例中食管病变67例,胃病变41例,十二指肠病变1例,结肠病变6例,直肠病变10例;病灶共143个,平均直径2.66cm。所有病灶均在内镜下完整切除,平均手术时间44.6min。术中少量出血占7.2%,延迟出血占4%,穿孔发生率4.8%,术后发热率12%,4例ESD后病理基底有癌细胞浸润追加外科手术治疗。住院时间4~50(平均11.87)d。随访3~31个月,其中1例残留,2例复发,6例出现食管狭窄,1例发生支气管胃食管瘘。[结论]ESD治疗消化道早癌及癌前病变是安全有效的,具有广阔的应用前景。虽然有出血、穿孔等并发症的发生,但随着内镜操作医师技术水平的提高,内镜器械的改进,可减少并发症的发生率。
[Objective] To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of early cancer of the digestive tract and precancerous lesions. [Methods] The surgical success rate, safety, complications and prognosis of 125 patients with early gastrointestinal cancer and precancerous lesions treated with ESD were retrospectively analyzed. [Results] 67 cases of esophageal lesions, 41 cases of stomach lesions, 1 case of duodenal lesions, 6 cases of colon lesions, 10 cases of rectal lesions; 143 lesions, the average diameter of 2.66cm. All lesions were completely removed under endoscopy, the average operation time 44.6min. A small amount of intraoperative bleeding accounted for 7.2%, delayed bleeding accounted for 4%, perforation rate of 4.8%, postoperative fever rate of 12%, 4 cases of ESD pathology basal with cancer cell infiltration additional surgical treatment. Hospitalization time 4 ~ 50 (average 11.87) d. All cases were followed up for 3 to 31 months, of which 1 remained, 2 recurred, 6 had esophageal stenosis and 1 had bronchial gastroesophageal fistula. [Conclusion] ESD is safe and effective in the treatment of early cancer and premalignant lesions of digestive tract, and has broad application prospects. Although there are bleeding, perforation and other complications, but with the endoscopic surgeons improve the technical level, the improvement of endoscopic instruments, can reduce the incidence of complications.