目的 觀察內鏡黏膜剝離術（ESD）下治療早期食管癌的療效及安全性。 方法 以2009年1月－2012年6月在我院消化內鏡中心就診的患者為研究對象，以內鏡黏膜切除術（EMR）為對照，回顧性分析接受ESD和EMR治療的共75例早期食管癌患者的臨床資料，比較兩組患者病灶整塊切除率、組織學治愈切除率、手術時間及并發癥等。 結果 共納入75例患者，其中41例患者接受ESD治療，34例接受EMR治療。ESD和EMR組病灶整塊切除率分別為90.2%（37/41）和44.1%（15/34）；治愈切除率分別為78.0%（32/41）和50.0%（17/34），整塊切除率（P＜0.001）和治愈切除率（P=0.011）在兩組間的分布差異均有統計學意義。ESD組患者手術平均時間（39.5 ± 11.4）min，而EMR組手術平均時間（33.5 ± 18.6）min，但二者之間的差異無統計學意義（P=0.091）。此外，術后延長出血和穿孔等并發癥在兩組間的分布亦無明顯差異。 結論 早期食管癌患者接受ESD治療可獲得更高的整塊切除率和組織學治愈切除率。
Objective To investigate the strategy of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Method Reviewing the related literatures at home and abroad in recent years, to summarize the progress of treatment and prevention of hemorrhage after radical resection of hilar cholangiocarcinoma. Results We should clear the postoperative bleeding time, extent, cause, and location, to help the clinician to choose the appropriate timing of intervention and treatment. The patients with early hemorrhage and mild degree hemorrhage could be treated conservatively. If patients with severe hemorrhage and hemodynamic disorders, surgical intervention must be decisive. Patients with late hemorrhage would have serious consequences, and these patients should receive interventional or surgical treatment as early as possible. Conclusions For patients with hilar cholangiocarcinoma after radical resection, doctors need to do accurate preoperative evaluation, meticulous operation, and intensive management after operation, to reduce the incidence of hemorrhage after radical resection of hilar cholangiocarcinoma. If the postoperative hemorrhage occurs, the cause, location, time, and degree of hemorrhage should be clearly defined to facilitate clinicians to make rapid clinical decisions and to develop treatment programs.