| 摘要: |
| 目的 评价内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗早期胃癌及癌前病变的安全性、有效性，为早期胃癌及癌前病变的内镜治疗提供依据。方法 回顾性分析2012年10月到2014年8月在第二军医大学长海医院消化内镜中心接受ESD治疗的214例胃黏膜病变患者的临床资料，分析术前评估、病理特征、ESD治疗及术后随访等情况。结果 214例患者术前评估中，接受内镜窄带成像（narrow band imaging，NBI）检查者67例（31.3%），NBI联合放大内镜（magnifying endoscopy，ME）检查者39例（18.2%），超声内镜（endoscopic ultrasonography，EUS）检查者50例（23.4%），CT检查者50例（23.4%），活组织检查者192例（89.7%）。214例病灶术后病理中，低级别上皮内瘤变84例（39.2%）、高级别上皮内瘤变55例（25.7%）、高分化癌45例（21.0%）、中分化癌19例（8.9%）、低分化癌11例（5.1%）。ESD整块切除率为96.3%，完整切除率为92.1%；ESD手术时间为14~290 min，平均（59.9±49.6） min；术中大出血2例（0.9%），术中穿孔2例（0.9%）；术后延迟出血5例（2.3%），术后复发5例（2.3%），无患者发生术后延迟性穿孔。结论 ESD是治疗早期胃癌及癌前病变的有效手段，但应进行完善的术前评估以避免不必要或过度的ESD治疗，术后定期随访是监测术后病灶残留与复发的有效手段。 |
| 关键词: 内镜黏膜下剥离术 胃肿瘤 癌前病变 治疗结果 |
| DOI：10.16781/j.0258-879x.2017.07.0923 |
| 投稿时间：2017-01-02修订日期：2017-03-06 |
| 基金项目: |
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| Clinical value of endoscopic submucosal dissection in early gastric cancer and precancerous lesion |
| WANG Wei,HAO Lu,SHI Xin-gang*,JIN Zhen-dong,LI Zhao-shen |
(Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To assess the safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer and precancerous lesion, so as to provide basis for its clinical application. Methods Clinical data of 214 patients with gastric mucosal lesion, who underwent ESD treatment in Digestive Endoscopy Center of Changhai Hospital of Second Military Medical University from Oct. 2012 to Aug. 2014, were retrospectively analyzed to assess the features such as the preoperative evaluation, pathology, ESD treatment and post-operative follow-up. Results Among 214 patients, 67 (31.3%) received narrow band imaging (NBI) examination, 39 (18.2%) NBI combined with magnifying endoscopy (ME), 50(23.4%) endoscopic ultrasonography (EUS), 50(23.4%) CT, and 192 (89.7%) biopsy during the pre-operative evaluation. Pathological results showed that, among all included patients, low-grade intraepithelial neoplasia accounted for 39.3%(84 cases), high-grade intraepithelial neoplasia 25.7%(55), well differentiated carcinoma 21.0%(45), moderately differentiated carcinoma 8.9%(19), and poorly differentiated carcinoma 5.1%(11). The en bloc resection rate of ESD was 96.3% and the complete resection rate was 92.1%. The operation time of ESD ranged from 14 min to 290 min, a mean of (59.9±49.6) min. There were two cases (0.9%) had severe intra-operative hemorrhage, two (0.9%) intraoperative perforation, five (2.3%) delayed hemorrhage, 0 delayed perforation and five (2.3%) recurrence. Conclusion ESD is a safe and effective method in the treatment of early gastric mucosal lesion. Comprehensive pre-operation evaluation is needed to avoid unnecessary or excessive ESD treatment. Regular follow-up after operation is effective to monitor residual tumor and recurrence. |
| Key words: endoscopic submucosal dissection stomach neoplasms precancerous lesion treatment outcome |
