内镜黏膜下剥离术治疗食管肿瘤的临床价值彭贵勇，武育卫，龙庆林，陈磊，赵京晶，周倩(第三军医大学西南医院全军消化病研究所，重庆400038)摘要：目的探讨内镜黏膜下剥离术(endoscopicsubmucosaldissection,ESD)在食管肿瘤治疗中的价值。方法利用染色内镜及超声内镜探测病变范围及侵犯深度，对位于黏膜层及黏膜肌层的早期癌、癌前病变、黏膜下肿瘤等病变行ESI)治疗。丁-病灶边缘2mm处用氟气刀标记切除范围，丁-病灶及周围黏膜卜•注射tt油果糖使病变91古I有肌层柑分离；沿标记线外侧切开病变周围黏膜；剥离病变卜•方黏膜卜层组织，完整切除病变。结果21例病灶，最大肖径均人于2cm,病灶最大者直径5cnio8例早期食管黏膜内癌，5例食管黏膜中、重度异型増生及8例食管平滑肌瘤经ESD—次性完全切除。ESD手术时间30〜180min,平均110min；术中少量出血均经电凝止血;术后无迟发性出血发生;1例早期食管癌术屮发生穿孔(4.76%),经内镜金属夹封闭、内科保守治疗后痊愈。术后随访1〜12个月无复发。结论在超声内镜及色素内镜的指导卜，采用内镜黏膜卜剥离术治疗食管黏膜内癌、癌前病变及黏膜肌层的肿瘤，是一项安全有效的内镜治疗方法。关键词：食管：早期癌；黏膜下肿瘤；内镜黏膜下剥离术中图法分类号：文献标识码：AThetreatmentoftumorofEsophagusbyEndoscopicSubmucosalDissectionPengGui-yong,WuYu-wei,LongQing-ling,ChenLei,ZhaoJing-jign,ZhouQian(SouthwestHospital,ThirdMilitaryMedicalUniversity,Chongqing400038,China)Abstract：ObjectiveTheaimofthisstudywastoinvestigatethevalueofEndoscopicsubmucosaldissection(ESD)intreatmentoftumorsinesophagus・MethodsTheproperties,rangeandinfiltratingdepthoftheneoplasticlesionsinesophagusweredetecteddependingonchromoendoscopandendoscopicultrasonograpy・Themucosallesionsincludingearlycancers,submucosaltumorsderivingfrommucosawereremovedbyESD.(1)injectingFructose-glycerolfluidintothesubmucosatoelevatethelesionfromthemusclelayer;(2)pre-cuttingthesurroundingmucosaofthelesion;(3)dissectingtheconnectivetissueofthesubmucosabeneaththelesion.Results21lesionsindiameterwerelargerthan2cm,thelargestdiameteroflesionwas5cm.Allthelesionsincluding8casesofearlyesophagealcancer,5casesofesophagealmucosamoderateandseveredysplasiaand8casesofesophagealleiomyomawereremovedbyESDcompletely.ThetimeofESDoperationwas30-180minutes,anaverageof110minutes;Asmallamountofintraoperativebleedingwereelectrocoagulationhemostasis;nodelayedpostoperativebleeding;oneperforationoccurredinapatientofearlyesophagealcancer(4.76%),andwascuredbyendoscopicmetalclipclosureandmedicalconservativetreatment.Follow-upof1〜11monthswithoutrecurrenc.ConelusionUndertheguidanceofchromoendoscopyandendoscopicultrasonography,endoscopicsubmucosaldissectionisasafeandeffectiveendoscopictreatmentmethodintreatmentofesophagealmucosalcancer、precancerouslesionandsubmucosaltumor.Keywords：Esophagus;Earlycancer;Submucosaltumor;Endoscopicsubmucosaldissection内镜黏膜下剥离术(endoscopicsubmucosaldissection,ESD)是最近开展起來的内镜治疗方法,常用来治疗黏膜切除术不能一次性切除的消化道早期癌及癌前病变九彳。现总结2007年12月至2009年2月我们采用ESD切除的食管肿瘤资料，报告如下。1资料与方法1.1临床资料食管早期癌8例，包括食管上段2例，中段5例，下段1例，均为鳞癌，病灶直径2^6cm,其屮男性5例，女性3例,年龄53〜68岁，平均61.4岁。食管黏膜中、重度异型增生5例，直径2〜3cm,其中男性4例，女性1例，年龄55〜64岁，平均60.2岁。消化道黏膜卞肿瘤8例，均为平滑肌瘤，直径2.2〜5cm,其中男性4例,女性4例,年龄22〜62岁,平均48.8岁。1.2器材电子内镜：OlympusGIFXQ-260；超声内镜：OlympusLIM-2R及LIM-3R超声小探头,超声频率为12、20MHz；XM24L21注射针，FD21U21热活检钳,11X2610213...