内镜下黏膜剥离术和内镜下黏膜切除术治疗食管黏膜病变的疗效比较

目的 将内镜下黏膜剥离术（ESD）和内镜下黏膜切除术（EMR）进行比较,评价ESD治疗食管黏膜病变的有效性及安全性.方法 分析25例经ESD治疗（ESD组）和45例经EMR治疗（EMR组）的食管黏膜病变患者的临床资料,比较两种方法病灶整块切除率、组织学治愈性切除率、手术时间、并发症情况及局部复发率.结果 ESD组病灶整块切除率为60.0％（15/25）,组织学治愈性切除率为48.0％（12/25）,均优于EMR组的48.9％（22/45）和40.0％（18/45）,差异有统计学意义（P＜0.05）.ESD组局部复发率为4.0％（1/25）,明显低于EMR组的20.0％（9/45）,差异有统计学意义（P＜0.05）.两组术后迟发性出血、穿孔、狭窄等严重并发症的发生率比较差异无统计学意义（P＞0.05）.ESD组手术时间（64.3±27.1） min,明显长于EMR组的（27.6±14.1） min,差异有统计学意义（P＜0.05）.结论 ESD和EMR相比,病灶整块切除率及组织学治愈性切除率高,局部复发率低,是治疗食管黏膜病变更为安全有效的方法.

Observation on efficacy of endoscopic submucosal dissection and endoscopic mucosal resection in the therapy of esophageal mucosal disease

Objective To evaluate the outcome and safety of endoscopic submucosal dissection （ESD） versus endoscopic mucosal resection （EMR） in the management of esophageal mucosal lesion.Methods The clinical data of 70 patients with esophageal mucosal lesion were analyzed.Twenty-five patients were treated by ESD （ESD group） and 45 patients were treated by EMR （EMR group）.The enbloc resection rate,tissue healing resection rate,operation time,complication and recurrence rate were compared between two groups.Results The enbloc resection rate,tissue healing resection rate in ESD group were significantly higher than those in EMR group [60.0%（15/25） vs.48.9%（22/45）,48.0%（12/25） vs.40.0% （18/45）] （P 〈0.05）.The local recurrence rate in ESD group was lower than that in EMR group [4.0% （1/25） vs.20.0% （9/45）] （P 〈 0.05）.The severe complication such as delayed hemorrhage,perforation,stenosis between two groups had no significant difference （P 〉 0.05）.The operation time in ESD group was （64.3 ±27.1） min,and significantly longer than that in EMR group [（27.6 ± 14.1） min] （P 〈0.05）.Conclusions Compare with EMR,ESD has better enbloc resection rate,tissue healing resection rate,and lower recurrence rate.It is more safe and effective in the therapy of esophageal mucosal disease.