Xu Li Hua, Jun Bo Qian, Liu Gen Gu, Fei Lu, Ya Min Wang, Yu Ming Li, Hua Sheng Lu
Department of Gastroenterology, The First People's Hospital of Nantong, Jiangsu, People's Republic of China.
Can J Gastroenterol. 2011 Feb;25(2):97-101. doi: 10.1155/2011/135060.
Endoscopic submucosal dissection (ESD) is a promising technique for the treatment of large, pre- and early malignant gastrointestinal lesions.
To assess the rates of en bloc resection, incidence of complications, procedure times and therapeutic outcomes of ESD using an insulated-tip diathermic knife; and to investigate predictors of these outcomes based on the final pathological features of biopsy specimens.
One hundred twenty patients with endoscopically suspected gastric epithelial tumours who were treated with ESD from January 2006 to December 2009 were evaluated.
The mean diameter of the gastric epithelial tumours in the present cohort was 1.88 cm. The mean diameter of the resected specimens was 3.33 cm. The en bloc resection rate was 90% (108 of 120). The median length of the operation was 64.6 min. The bleeding and perforation complication rates were 5.0% (six of 120) and 2.5% (three of 120), respectively. Of 10 gastric tumours initially diagnosed as adenocarcinoma on biopsy, four were found to be low-grade dysplasia and six were found to be high-grade dysplasia after resection and final pathological examination. A total of 112 (93.33%) patients underwent curative treatment, eight patients (6.67%) underwent noncurative treatment with ESD, and two patients (1.67%) experienced local recurrence and subsequently underwent surgery.
ESD is a promising local curative treatment option for gastric epithelial tumours, but still carries the risks of bleeding and⁄or perforation. Differences in the interpretation of histological results among different pathologists and⁄or between biopsy specimens before ESD and the en bloc tissue specimens after ESD will result in discrepancies.
内镜黏膜下剥离术（ESD）是一种治疗大型、癌前及早期恶性胃肠道病变的有前景的技术。
评估使用绝缘头电刀进行ESD的整块切除率、并发症发生率、手术时间和治疗效果；并根据活检标本的最终病理特征研究这些结果的预测因素。
对2006年1月至2009年12月接受ESD治疗的120例内镜疑似胃上皮肿瘤患者进行评估。
本队列中胃上皮肿瘤的平均直径为1.88 cm。切除标本的平均直径为3.33 cm。整块切除率为90%（120例中的108例）。手术的中位时长为64.6分钟。出血和穿孔并发症发生率分别为5.0%（120例中的6例）和2.5%（120例中的3例）。在最初活检诊断为腺癌的10例胃肿瘤中，切除及最终病理检查后发现4例为低级别异型增生，6例为高级别异型增生。共有112例（93.33%）患者接受了根治性治疗，8例患者（6.67%）接受了ESD非根治性治疗，2例患者（1.67%）出现局部复发，随后接受了手术。
ESD是胃上皮肿瘤一种有前景的局部根治性治疗选择，但仍有出血和/或穿孔的风险。不同病理学家之间和/或ESD前活检标本与ESD后整块组织标本之间组织学结果解读的差异会导致差异。
