食管内镜黏膜下剥离术后迟发性动脉出血1例

doi:10.3877/cma.j.issn.2095-7157.2023.02.012

中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (02) : 138 -140. doi: 10.3877/cma.j.issn.2095-7157.2023.02.012

病例报告

食管内镜黏膜下剥离术后迟发性动脉出血1例

智佳, 冯佳^†(

), 刘宗, 冯子坛, 于佳, 王春华, 靳海峰

050082　石家庄，联勤保障部队第980医院消化内科

收稿日期:2023-03-21 出版日期:2023-05-15
通信作者: 冯佳
基金资助:
河北省医学科学研究重点课题(20170204)

Delayed arterial bleeding after esophageal endoscopic submucosal dissection: a case report

Jia Zhi, Jia Feng^†(), Zong Liu

Received:2023-03-21 Published:2023-05-15
Corresponding author: Jia Feng

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内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)是目前早期消化道癌以及癌前病变的重要治疗手段，能将黏膜病变进行完整切除。ESD术后出血是最常见的并发症之一，相较于胃ESD术后出血，食管ESD和肠道ESD术后出血更为少见^[1-2]。联勤保障部队第980医院消化内科1例食管高级别上皮内瘤变行ESD术后出现迟发性动脉出血，通过外科手术止血成功。目前ESD开展广泛，但食管ESD术后迟发性动脉出血罕见，现报道如下。

图1 病变白光下形态

图2 病变复方碘染色后形态

图3 ESD术后创面

图4 黏膜下肿物ESD后部分暴露

图5 喷射性出血

图6 气管插管后再次胃镜检查

图7 术中见3支粗大固有动脉

图8 术中止血后再次胃镜检查

图9 术后5个月ESD处黏膜瘢痕样改变

图10 术后5个月ESD处黏膜瘢痕样改变

图11 术后5个月黏膜下隆起

图12 术后5个月ESD处黏膜活检病理

[1]	Yosuke K，Yosuke T，Yoshiki S，et al.Bleeding after endoscopic submucosal dissection：risk factors and preventive methods[J]．World J Gastroenterl，2016，22(26)：5927-5935.
[2]	Tsujii Y，Nishida T，Nishiyama O，et al.Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms：a multicenter retrospective cohort study[J]．Endoscopy，2015，47(9): 775-783.
[3]	van Vilsteren FGI，Pouw RE，Herrero LA，et al.Learning to perform endoscopic resection of esophageal neoplasia is associated with significant complications even within a structured training program[J]．Endoscopy，2012, 44(1): 4-12.
[4]	Joon Sung Kim BK.Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia：a metA－analysis[J]. Dig Dis Sci，2014，59(8): 1862-1869.
[5]	Bai Y，Cai JT，Chen YX，et al.Chinese Society of Digestive Endoscopy. Expert consensus on perioperative medications during endoscopic submucosal dissection for gastric lesions (2015, Suzhou, China)[J]．J Dig Dis, 2016，17(12)：784-789.
[6]	Lim SM，Park JC，Lee Hey，et al.Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm[J]．Surg Endosc，2013，27(4)：1397-1403.
[7]	Yu Xinying，Liu Ong，Xue Liyan，et al.Risk factors for complications after endoscopic treatment in Chinese patients with early esophageal cancer and precancerous lesions[J]．Surg Endosc，2021，35(5)：2144-2153.
[8]	Koh R，Hirasawa K，Yahara S，et al.Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms[J]．Gastrointest Endosc，2013，78(3)：476- 483.
[9]	Matsumura T，Arai M，Maruoka D，et al.Risk factors for early and delayed post-operative bleeding after endoscopic submucosal dissection of gastric neoplasms, including patients with continued use of antithrombotic agents[J]．BMC Gastroenterol，2014，14：172.
[10]	胡兵，唐承薇．消化道动脉性出血多学科处理[C].2012中国消化系疾病学术大会论文集，2012：125-126.
[11]	贾中芝，蒋国民．食管支架致消化道大出血一例[J]．中华胃肠外科杂志，2018，21(3)：356-356.
[12]	卢忠生，令狐恩强，黄启阳，等．内镜黏膜下剥离术治疗消化道早期癌及癌前病变[J]．中华消化内镜杂志，2008，25(11)：578-583.
[13]	Shinichi M，Songde C，Shinya N，et al.Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD[J]．Surg Endosc, 2013，27(4)：1292-1301.

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