| Objective 1. Analysis on short-term clinical curative effect of Endoscopic Submucosal Dissection the treatment of Gastric Lesions. 2. Research on the safety of ESD and Clinical Risk Factors of Complications. Methodology This research collects 58 cases from 57 patients who have received ESD treatment by The First Affiliated Hospital of Dalian Medical University during Feb 2012 to Jan 2015. The following data has been collected and recorded during the research: preoperative information, lesion and its size, preoperative endoscopic biopsy results, operation time, perioperative complications and intraoperative complications, pathology results and length of hospitalization. This research then calculates the disposable en bloc resection rate of the lesion, Histological curative resection rate and Preoperative and postoperative pathological coincidence rate. SPSS is applied in this research for description and analysis of the cases. Results 1.In all ESD surgical cases, 51 are completed(87.93%), and 7 are not completed among which 5 cases are terminated(8.62%) and the other 2 cases render negative or undesirable flattering sign(including one case with perforation and the other case with massive bleeding). The bleeding case and perforation case are cured through treatments such as intraoperative endoscopic hemostasis, suture and water fasting, gastrointestinal decompression, and intravenous drug treatment. These two cases accept elective surgery and remove pathological lesions with results recorded. Intraoperative massive active bleeding occurs in one case(1.72%) with unable to complete endoscopic hemostasis. Intraoperative perforation occurs in once case(1.72%) with unable to complete endoscopic suture. The above bleeding and perforation cases all undergo emergency surgeries. Among the unfinished cases, five receive comprehensive conservative treatment for relief. ESD in the treatment of Gastric Lesions is relatively safe and most complications have get better recovery through conservative treatment. 2.In all completed ESD cases, the disposable en bloc resection rate is 98.04%, the histology curative resection rate is 78.43%, the average tumor size is 2.03 cm with longest diameter and 1.45 cm with widest diameter, the average operative time is 81.03 mins. Counting all the ESD cases, the average hospitalization time is 6.41 days, which shows an obvious shortness. As a new technology of treating superficial stomach disease, ESD shows its unique advantages compared to conservative surgery, EMR and endoscopic biopsy. 3.Early gastric cancer, gastric stromal tumor,coagulation abnormalities and lesions in the cardia-fundus are(all P<0.05) the independent risk factors of bleeding during ESD surgery. Lesions in the cardia-fundus(P<0.001) are the independent risk factor of perforation during ESD surgery. This research doesn’t find any other complication such as perioperative cardiovascular and cerebrovascular accidents and pneumonia and deep vein thrombosis. Conclusion ESD surgery is a technology with relatively high rate of en bloc resection and histological curative resection rate, which possesses advantages such as less trauma, quicker recovery and shorter hospitalization time. Not only can it achieve removals of multiple lesions, but also it can enable one patient to undergo multiple ESD surgical treatment. In addition, the rate of complications such as bleeding and perforation is relatively low, and most complications during ESD can be cured through endoscopic operation and conservative treatment. If the surgical indications are strictly controlled, ESD is a safe and liable treatment for stomach mucosa and Submucosal lesions. |
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