消化
词汇介绍
拓展阅读
解析
endoscopic 英 [ˌendəs'kɒpɪk] 美 [ˌendəs'kɒpɪk]
释义 adj. 内窥镜的；用内窥镜检查的
例句 Objective: To discuss gastrointestinal polyp typing and endoscopic therapy for " small polyp" .目的：讨论消化道息肉的分型与“小型息肉”内镜治疗。
submucosal [ˌsʌbmjʊˈkəʊsəl]
释义 adj. 粘膜下层的
例句 Arterial bleeding is seen in the submucosal layer. 动脉血在粘膜下层可看到。
dissection 英 [daɪ'sekʃn] 美 [dɪˈsɛkʃən, daɪ-]
释义 n. 解剖，切开；解剖体；详细查究
例句 However, as has been the case previously, the headline numbers, upon further review and dissection, may not be as positive as initially reported and received. 然而，正如之前的情况一样，经过进一步审查和剖析后，标题数字可能不如最初报告和收到的那样积极。
概述
概述
内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）是指利用各种电刀对大于2 cm的病变进行黏膜下剥离的内镜微创技术。这一技术可以实现较大病变的整块切除。并提供准确的病理诊断分期。随着内镜器械的不断发展，ESD已成为消化道早癌及癌前病变的首选治疗方法。
适应症
①大于15 mm的食管高级别上皮内瘤变；
③伴有不典型增生和癌变的Barrett食管；
④姑息性治疗；
①不论病灶大小，无合并溃疠存在的分化型黏膜内癌；
②肿瘤直径小于或等于30m，合并溃疡存在的分化型黏膜内癌；
③肿瘤直径小于或等于30mm，无合并溃疡存在的分化型sm1黏膜下癌；
④肿瘤直径小于或等于20mm，无合并溃疡存在的未分化型黏膜内癌；
⑤大于20mm的胃黏膜上皮内高级别瘤变；
⑥EMR术后复发或再次行EMR困难的黏膜病变；
⑦高龄、或有手术禁忌证、或疑有淋巴结转移的黏膜下癌，拒绝手术者可视为ESD相对适应证。
（3）早期结直肠癌及癌前病变
①无法通过EMR实现整块切除的、大于20mm的腺瘤和结直肠早痛。术前需通过抬举征、放大内镜或EUS评估是否可切除；
②拾举征阴性(non- lifting sign positive)的腺和早期结直肠；
③大于10mm的EMR残留或复发病变，再次EMR切除困难的病变；④反复活检仍不能证实为癌的低位直肠病变。
禁忌症
有严重的心肺疾病、血液病、凝血功能障碍以及服用抗凝剂的患者，在凝血功能未纠正前严禁行ESD。病变浸润深度超过sm1为ESD的相对禁忌证。
操作过程
（1）确定病变范围与深度；
（2）标记（marking）；
（3）黏膜下注射（submucosal injection）；
（4）切开（incision）；
（5）黏膜下刺离（submucosal dissection）；
（6）创面处理（wound management）；
（7）术中并发症的处理。
并发症
主要包括出血、感染、穿孔与疼痛，出血是最常见的并发症，其中以术中出血较为常见。
复制标题内镜黏膜下剥离术在未分化型早期胃癌中进一步扩大适应证的可行性
发表时间：2019-09-05
影响指数：5.6
作者： Yusuke Horiuchi
期刊：Gastric Cancer
Since the development of endoscopic submucosal resection (ESD), endoscopic resection has been possible for early gastric cancers (EGC) with a large tumor diameter. Therefore, the treatment of EGC has become less invasive [1–6]. However, because all undifferentiated-type EGCs (UDEGC) carry a high risk of lymph node metastasis (LNM), traditional surgical treatment remains the current standard treatment according to Japanese gastric cancer treatment guidelines [7]. However, Hirasawa et al. stratifed intramucosal UDEGC patients who underwent surgical resection based on tumor diameter, presence or absence of lymphatic invasion and vascular invasion, and presence or absence of ulcerative fndings [8]. Among patients with absence of ulcerative fndings, absence of lymphatic invasion, and absence of vascular invasion, none showed LNM in tumors with a diameter of≤20 mm [8]. Therefore, tumors with a diameter of≤20 mm and no LNM are listed in the Japanese gastric cancer treatment guidelines 2014 (ver. 4) as indicated for ESD as an investigational treatment (expanded indication) [7]. Two reports on the long-term prognosis after ESD in patients with these lesions have reported a 5-year survival rate of approximately 100% [9, 10]. However, there have also been reports of no signifcant differences in 5-year survival rates between patients who undergo surgery and those who undergo ESD [11].
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