内镜黏膜下剥离术治疗80岁多重血栓高危早期胃癌1例

Endoscopic Submucosal Dissection for Early Gastric Cancer in an 80-Year-Old Patient with Multiple High Thrombotic Risks: A Case Report

摘要: 随着内镜技术的不断发展，内镜诊疗技术已成为高龄上消化道早癌患者的重要治疗选择。放大内镜可清晰观察病变形态及微血管改变，精准评估病变性质。内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)作为主流微创手段，具有创伤小、恢复快、复发率低等优势，能最大程度地保留消化道功能，特别适合合并多种基础疾病的高龄患者，单次内镜即可完成诊断与治疗，显著降低了诊疗风险，提高了患者的生活质量，本例为超高龄、冠脉支架合并外周静脉血栓双重血栓高危早期胃癌患者，经多学科个体化抗凝干预后行ESD微创根治，兼顾血栓栓塞与消化道出血风险，证实该方案安全有效，可为同类特殊人群临床诊疗提供参考。

Abstract: With the continuous development of endoscopic technology, endoscopic diagnosis and treatment has become a crucial therapeutic option for elderly patients with early upper gastrointestinal tract cancers. Magnifying endoscopy allows clear observation of lesion morphology and microvascular changes, so as to accurately evaluate the nature of lesions. As a mainstream minimally invasive technique, endoscopic submucosal dissection (ESD) boasts advantages including minimal trauma, rapid postoperative recovery and low recurrence rate. It can preserve gastrointestinal function to the maximum extent, and is especially applicable to elderly patients complicated with multiple underlying diseases. Diagnosis and treatment can be completed in a single endoscopic procedure, which significantly reduces treatment-related risks and improves patients’ quality of life. This paper reports a case of an extremely elderly patient with early gastric cancer at dual high thrombotic risks, who had a history of percutaneous coronary intervention (PCI) and peripheral venous thrombosis. After receiving individualized perioperative antiplatelet intervention via multidisciplinary collaboration, curative minimally invasive ESD was performed. This regimen balances the risks of thromboembolism and gastrointestinal bleeding, which has verified its safety and effectiveness, and can provide references for clinical diagnosis and treatment of similar special populations.