目的：探讨内镜下黏膜剥离术( ESD)治疗上消化道广基息肉、黏膜下肿瘤的疗效和安全性。方法：对内镜发现的58例上消化道隆起性病变进行超声内镜检查（25例病变位于黏膜层，16例位于黏膜肌层，17例位于黏膜下层），应用HOOK刀及IT刀行内镜下黏膜剥离术治疗。黏膜下注射生理盐水抬高病变，使病变与肌层分离，预切开病变周围黏膜，剥离病变下方黏膜下层结缔组织，完整切除病变。结果：58例患者均成功完成ESD治疗，病变大小0.4~3.4 cm（平均1.5 cm），手术时间15~95 min (平均40 min)，无出血、穿孔等并发症。所有ESD剥离病变包膜完整，基底和切缘未见病变累及。结论：ESD治疗上消化道广基息肉、黏膜下肿瘤安全、有效，可以完整切除病变，提供完整的病理诊断资料。%Objective To assess the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for flat polyp and submucosal tumor (SMT) of the gastrointestinal tract. Methods Total 58 patients with muco-sal tumor of the gastrointestinal tract diagnosed by endoscopy were examined using endoscopic ultrasonography (EUS). Among the cases, 25 lesions were within the submucosa, 16 lesions were within the submucosa muscula-ris and 17 in the submucosa propria. The cases were managed by ESD with a HOOK and IT knife. After injec-tion of physiological saline solution into the submucosal layer to separate the lesion from the muscle layer, the mucosa surrounding the lesion was pre-cut, and the connective tissue of the submucosa beneath the lesion was dissected. Then, the lesion was resected completely. Results All lesions were successfully resected with ESD. The resected lesions sized 0.4~3.4 cm in diameter (mean,1.5 cm) . The mean ESD procedure time was 40 min (ranged from 15 to 95 min). None of the patients showed delayed bleeding after ESD. Histological evaluation showed that the tunica of the tumors was intact, and both the lateral and basal margins of the specimens were free of tumor cells. Conclusion ESD is an efficacious and safe procedure for the treatment of SMT of the gas-trointestinal tract. It is possible to completely resect submucosal lesions and provide sufficient pathologi- cal information.
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