發(fā)布時(shí)間：2018-06-16 15:48

  本文選題：內(nèi)鏡粘膜下剝離術(shù) + 胃部病變��； 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的1.分析內(nèi)鏡粘膜下剝離術(shù)(Endoscopic Submucosal Dissection ESD)治療胃部病變的短期臨床療效。2.研究?jī)?nèi)鏡粘膜下剝離術(shù)(ESD)的安全性和并發(fā)癥的臨床危險(xiǎn)因素。研究方法:收集自2012年2月至2015年1月大連醫(yī)科大學(xué)附屬第一醫(yī)院接受ESD治療胃部疾病病例共58例。記錄上述病例的術(shù)前檢查資料,包括病變部位、大小,術(shù)前內(nèi)鏡活檢病理結(jié)果,手術(shù)時(shí)間,圍手術(shù)期合并癥及術(shù)中并發(fā)癥,術(shù)后病理結(jié)果,住院時(shí)間。統(tǒng)計(jì)病變的一次性整塊切除率,組織學(xué)治愈性切除率、術(shù)前與術(shù)后病理符合率。應(yīng)用SPSS統(tǒng)計(jì)軟件對(duì)上述病例資料進(jìn)行描述以及分析。結(jié)果1.所有ESD病例中,完成51例(87.93%),未完成7例:ESD術(shù)中抬舉征陰性或明顯抬舉不良(其中1例穿孔,1例大量出血)終止操作5例(8.62%),其中出血和穿孔的病例經(jīng)術(shù)中內(nèi)鏡下止血、縫合及禁食水、胃腸減壓、靜脈應(yīng)用藥物治療等處置后治愈,并擇期接受外科手術(shù)治療切除病變,記錄術(shù)后病理結(jié)果。另外的2例未完成病例中,1例(1.72%為術(shù)中大量活動(dòng)性出血,內(nèi)鏡下無法徹底止血),1例(1.72%)為術(shù)中穿孔,內(nèi)鏡下無法縫合修補(bǔ)。綜上,前者5例(71.43%)接受綜合保守治療緩解,后者2例(28.57%)未完成病例中合并出血與穿孔的病例,均行急診外科手術(shù)。提示ESD在治療胃部病變相對(duì)安全,并且大部分并發(fā)癥經(jīng)保守治療后恢復(fù)效果較好。2.在完成的51例接受ESD的患者中,一次性整塊切除率達(dá)到98.04%,組織學(xué)治愈性切除率78.43%,切除的病灶大小平均為最長(zhǎng)徑2.03cm,最寬徑為1.45cm,平均手術(shù)時(shí)間81.03min,平均住院時(shí)間6.41天。ESD作為診治胃部淺表性疾病的新技術(shù),在和傳統(tǒng)外科手術(shù)、EMR和內(nèi)鏡下活檢等的比較中,在適應(yīng)征、術(shù)后恢復(fù)等方面均具有其獨(dú)特的優(yōu)勢(shì)。3.胃早癌、間質(zhì)瘤、凝血功能異常和病灶位于賁門-胃底(均P0.05)為ESD術(shù)中出血的獨(dú)立危險(xiǎn)因素。病灶位于賁門-胃底(P0.001)為ESD穿孔的獨(dú)立危險(xiǎn)因素,間質(zhì)瘤為可能的危險(xiǎn)因素。本研究中,未發(fā)現(xiàn)其他并發(fā)癥,如圍手術(shù)期心腦血管意外,肺炎及下肢靜脈血栓等。結(jié)論ESD是一項(xiàng)具有相對(duì)較高整塊切除率和組織學(xué)治愈性切除率的技術(shù),具有創(chuàng)傷小、恢復(fù)快、住院天數(shù)短等優(yōu)點(diǎn)。不僅可以一次手術(shù)操作可做到多處病變的切除,而且同一患者可接受多次ESD治療。出血、穿孔等并發(fā)癥的發(fā)生率也相對(duì)較低,且大多數(shù)可經(jīng)內(nèi)鏡下操作和綜合保守治療治愈。凝血功能異常、病灶位于賁門-胃底部以及早期胃癌、間質(zhì)瘤是其術(shù)中出血的獨(dú)立危險(xiǎn)因素,病灶位于賁門-胃底是術(shù)中穿孔的獨(dú)立危險(xiǎn)因素。嚴(yán)格把握ESD的手術(shù)適應(yīng)征,并且關(guān)注其危險(xiǎn)因素的情況下,ESD是胃部粘膜和粘膜下病變的安全、可靠的治療方法。
[Abstract]:Objective 1. Objective to analyze the short-term clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of gastric lesions. To study the safety and clinical risk factors of endoscopic submucosal dissection (ESD). Methods: from February 2012 to January 2015, 58 cases of gastric diseases were treated with ESD in the first affiliated Hospital of Dalian Medical University. The preoperative examination data were recorded, including lesion location, size, pathological results of preoperative endoscopic biopsy, operative time, perioperative complications, postoperative pathological results and hospitalization time. The rate of one piece resection, the rate of histologically cured resection, and the rate of preoperative and postoperative pathology were calculated. The data of above cases were described and analyzed by SPSS software. Result 1. Of all the ESD cases, 51 completed 87.93s, and 7 failed to complete the termination of the operation (1 perforation and 1 massive hemorrhage) in which 7 cases were negative or significantly poor in lifting during the operation. The bleeding and perforation cases were hemostasis under endoscope during the operation. Suture and fasting water, gastrointestinal decompression, intravenous drug therapy were cured, and surgical treatment was performed to remove the lesions. The pathological results were recorded. In the other 2 cases, 1 case (1.72%) was found to have massive active bleeding during operation, and 1 case was unable to stop bleeding completely under endoscope (1 case) was perforated during operation, and there was no suture and repair under endoscope. In conclusion, the former 5 cases (71.43) were treated with comprehensive conservative treatment and the latter 2 cases (28.57%) with hemorrhage and perforation were all performed emergency surgery. The results suggest that ESD is relatively safe in the treatment of gastric lesions, and the recovery of most complications after conservative treatment is better. 2. 2. Of the 51 patients who received ESD, The resection rate was 98.04, the resectability rate of histologic cure was 78.43. The average diameter of lesion was 2.03 cm, the widest diameter was 1.45 cm, the average operation time was 81.03 min, the average hospitalization time was 6.41 days. ESD was a new technique for the diagnosis and treatment of superficial gastric diseases. Compared with conventional surgical procedures, EMR and endoscopic biopsy have their unique advantages in adaptation and postoperative recovery. Early gastric carcinoma, stromal tumor, abnormal coagulation function and lesion located in cardia-gastric fundus (P0.05) were independent risk factors for bleeding during ESD. P0.001) was an independent risk factor for ESD perforation and stromal tumor was a possible risk factor. In this study, no other complications were found, such as perioperative cardio-cerebrovascular accidents, pneumonia, and venous thrombosis of the lower extremities. Conclusion ESD is a technique with relatively high mass resection rate and histological curable resection rate, which has the advantages of less trauma, faster recovery and shorter hospital stay. Not only can multiple lesions be resected in one operation, but also the same patient can be treated with multiple ESD. The incidence of bleeding, perforation and other complications is relatively low, and most of them can be cured by endoscopic operation and comprehensive conservative treatment. Abnormal coagulation function, the lesion located in the cardia-stomach fundus and early gastric cancer, stromal tumor is the independent risk factor of intraoperative hemorrhage, the focus located in the cardia-stomach fundus is the independent risk factor of intraoperative perforation. ESD is a safe and reliable treatment for gastric mucosal and submucosal lesions.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.2

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