27Vol.1No.32007DigestiveDiseaseandEndoscopy·中国消化内镜采用针形电刀行黏膜下整片切除术（ESD）治疗早期胃癌及胃癌前病变8例报道刘思德张亚历白岚智发朝陈村龙潘德寿万田谟周丹张振书周殿元姜泊（南方医科大学附属南方医院消化内科，广州，510515）【摘要】目的近年来，日本已有多家报道采用先端带陶瓷绝缘头的IT电刀（Insulation-tippedDiathermicKnife）行早期胃癌的黏膜下整片切除术（EndoscopicSubmucosalDissection，ESD），取得了优于传统黏膜切除术（EndosopicMucosalResection，EMR）的良好效果，但IT电刀目前尚未引进中国，用针形电刀行ESD术国内尚未见报道，我们采用传统的针形电刀进行黏膜下整片切除术（ESD）治疗早期胃癌及癌前病变共8例，均成功切除。方法患者8例，男5例，女3例，平均年龄52.7岁，行常规内镜检查加活检及超声内镜检查，诊断为早期胃癌3例（低分化腺癌，浸润至黏膜肌层），萎缩性胃炎伴中-重度不典型增生5例，病变直径2.2～5.0厘米，平均3.7厘米，病变分布：胃窦6例，胃体2例。无手术禁忌，均采用针形电刀下的ESD术行病变切除，针形电刀采用Olympus公司乳头切开专用针刀（KD-10Q-1），内镜为OlympusGIFQ240Z，手术步骤如下：先于病变边缘0.5厘米处用针形刀作边缘环周标记，再行黏膜下注射生理盐水至病变边缘明显隆起，然后用针刀沿标记的外侧缘进行环周切开，再沿切缘行黏膜下层分离，术中出血用热凝固止血钳止血，最后整片完整将病变切除。结果8例均切除成功，手术时间47～195分钟，平均106分钟，同期42例胃EMR术平均时间为17分钟。术后3～6个月胃镜复查均无病变残留。并发症：术中出血6例，其中出血量超过200毫升的4例，一例出血600毫升，均于术中用内镜下热凝固止血钳止血成功。无穿孔发生。结论采用针形电刀行胃ESD术有可行性，但存在出血发生率过高、操作难度大、手术时间较长等缺点。【关键词】黏膜下整片切除术;早期胃癌TheEndoscopicSubmucosalDissection(ESD)PerformedbyNeedleKnifeforEarlyGastricCancerorPrecancerousLesions:With8CasesReportedLIUSi-deZHANGYa-liBAILanZHIFa-chaoCHENCun-longPANDe-shouWANTian-moZHOUDanZHANGZhen-shuZHOUDian-yuanJIANGBoDept.ofGastroenterology,NanfangHospital,TheNanfangMedicalUniversity,Guangzhou,510515[Abstract]Objective:Intheseyears,anewendoscopicsurgeryprocedureforearlygastriccancerhadreportedbyJapanendoscopist,thatisendoscopicsubmucosaldissection(ESD)byITknife.Mostofthosereportssuggestedtheresectioneffectisbetterthantheendosopicmucosalresection(EMR).TheITknifehavenotlicenseinChinamainlandbynow,soweusetheclassicneedleknifeinsteadofITknifetoperformtheESDprocedure.EightpatientstotalofearlygastriccancerorprecancerouslesionshadresectedbyneedleknifeESDprocedureandall8lesionshadbeensuccessfuleliminated.Method:Atotalof8patientswasperformedneedleknifeESDprocedure,averageage52.7years,5patientsismaleandother3isfemale.Allpatientsacceptedthegeneralendoscopeand/orechoultrasoundendoscopeandhistopathologyexaminationbeforeoperation.Thediagnosisisearlygastriccancerfor3patientsandhigh-gradeintraepithelialneoplasiafor5patients.Thelesionsdiameterwasamong2.2~5.0centimeters,averagediameterwas3.7centimeters.Sixlesionswassitedonantrumandtwolesionssitedonbody.TheOlympusKD-10Q-1needleknifewasusedtoESDprocedure.First,markingthelesionsmarginusedneedleknifewithcoagulationmode,nexttoinjectnormalsalineintosubmucosal,thanperformedthearoundcutusingneedleknife.Afteraroundcut,carefullyseparatedthesubmucosallayeruntilthelesionbecompletelyremoved.Tostopbleedingwhichoccurringinoperationwasusingthehotbiopsyforceps.Results:All8lesionswereremovedsuccessfulandfollowupfor3~6monthsbyendoscopysuggestednoresiduallesion.Theoperativetimewasbetween47~195minutesandaveraged106minutes,butonly17m...
