内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法收集2012年6月-2015年6月在郑州大学附属郑州中心医院消化内科接受ESD治疗的106例EGC或癌前病变患者的临床资料,统计分析ESD治疗效果、并发症、术后病理及远期疗效。结果病灶整块切除率为100.0%,平均手术时间为(61.8±17.3)min,病灶平均直径为(2.7±1.3)cm。无内镜下难以控制的大出血发生;术中穿孔及术后迟发性出血的发生率分别为6.6%及5.7%,均于内镜下处理后好转,无外科手术情况。术后病理结果提示胃早癌74例:高分化腺癌23例,中分化腺癌29例,低分化腺癌19例,印戒细胞癌3例;高级别上皮内瘤变32例;7例标本存在基底部肿瘤侵犯,无切缘阳性病例,R0切除率为93.4%,R1切除率为6.6%。7例R1切除患者经内镜下二次切除后达到R0切除。5例于术后1年内复发,复发率为4.7%,均接受根治性胃大部切除术。截至2016年12月,中位随访期为34个月,3年生存率达97.9%。结论 ESD治疗EGC及癌前病变安全可行,并具有创伤小、恢复快、并发症少和疗效可靠等优点,且临床疗效与外科手术相似。

Clinical efficiency of endoscopic submucosal dissection in treatment of gastrointestinal neoplasms

Abstract: Objective To discuss the clinical efficiency of endoscopic submucosal dissection (ESD) in treatment of early gastric cancer (EGC) and precancerous lesions. Method Clinical data of 106 patients with EGC or precancerous lesions who received the treatment of ESD from June 2012 to June 2015 was collected. Then analyzing the treatment effect, complications, postoperative pathology and long-term efficacy of ESD. Results The overall en bloc resection rate was 100.0%, the mean operation time was (61.8 ± 17.3) min and the mean diameter of the lesions was (2.7 ± 1.3) cm. No endoscopic massive haemorrhage occurred; The incidence of perforation and postoperative delayed bleeding was 6.6% and 5.7% respectively, which were cured by endoscopic treatment and there was no surgical treatment. Postoperative pathological results showed high differentiated adenocarcinoma in 23 cases, moderately differentiated adenocarcinoma in 29 cases, poorly differentiated adenocarcinoma in 19 cases, signet ring cell carcinoma in 3 cases and high grade intraepithelial neoplasia in 32 cases. Among them, 7 cases with basal tumor invasion, and there were no margin positive cases. So the R0 resection rate was 93.4% and the R1 removal rate was 6.6%. The 7 cases with R1 resection reached R0 resection after second endoscopic treatment. 5 cases recurred within 1 years after the operation, and the recurrence rate was 4.7%. Up to December 2016, 3 patients died, the median follow-up period was 34 months and the 3 year survival rate was 97.9%. Conclusion ESD is safe and feasible in the treatment of EGC and precancerous lesions with the advantages of less trauma, faster recovery, less complications and reliable curative effect. Its clinical efficiency is similar to surgery.