内镜黏膜下剥离术治疗不同部位消化道早癌及癌前病变的临床研究

目的评估内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗消化道早癌及癌前病变疗效及风险,比较不同部位病变内镜下微创治疗的疗效。方法回顾性分析北京军区总医院消化内镜中心2012年6月-2013年6月内镜下切除且病理明确诊断的消化道早癌及癌前病变126例,其中咽部2例、食管23例、胃38例、结肠60例、十二指肠3例。将126例病变按照以往报道并发症发生率及医生操作经验分为内镜下易于治疗组(easy treat;n=67)和难于治疗组(difficult treat;n=59),比较两组患者病变大小、平均手术时间、手术成功率及并发症发生率等。结果整体手术切除标本平均直径为(5.0±1.3)cm,平均手术时间为(84.9±17.5)min,整块切除率96.0%,完整切除率91.3%,并发症发生率为9.5%,原位复发率为4.0%。两组切除标本平均面积为(4.4±0.6)cm2和(5.3±1.1)cm2,两组比较,差异无统计学意义(P0.05)。两组并发症发生分别为5例和7例,差异无统计学意义(P=0.234)。两组不完整切除分别为1例和3例,差异无统计学意义(P=0.500)。两组非整块切除分别为4例和7例,差异无统计学意义(P=0.360)。难于治疗组所花时间多于易于治疗组,平均时间分别为(44.8±9.7)min和(78.3±15.5)min,差异有统计学意义(P0.05)。结论 ESD治疗消化道早期癌及癌前病变,效果好,治愈率高。对于比较难以实施ESD操作的部位,如食管、贲门、乙状结肠等只要医生努力提高操作水平,操作过程中有足够的耐心,同样可以达到安全、完整切除病变的目的。

Clinical research of ESD treatment in different parts of early gastrointestinal cancer and pre-cancerous lesions

Objective To assess the curative effect and risk of endoscopic submucosal dissection （ESD） for curing premalignant lesions and noninvasive early gastrointestinal cancers, compare different effects on tumor operation. Meth- ods One hundred and twenty-six patients with lesions of gastrointestinal tract detected by endoscopy and pathology from Jun. 2012 to Jun. 2013 of Beijing Military General Hospital were analyzed retrospectively, including pharyngeal 2 ca- ses, esophagus 23 cases, gastric 38 cases, colonic 60 cases, duodenal 3 cases. The 126 cases of lesions were divided into easy-to-implement ESD operative parts of the lesions （ n = 67） and difficult to operate parts of the lesions （ n = 59）. Lesion size, mean operation time, success rate and complication rate were compared between two groups. Results The average diameter of resection samples was （5.0 ± 1.3 ） cm. The average of operation time was （84.9±17.5 ） minutes. The enbloc resection rate was 96.0% , R0 resection rate was 91.3%. The complication rate was 9.5%. Local recur- rence rate was 4.0% . The average area were （4.4 ±0.6） cm2 and （5.3 ± 1.1 ） cm2, there was no statistically signifi- cant difference between two groups （P 〉 0.05）. Two complications were 5 cases and 7 cases, the incidence had no sig- nificant difference （X2 = 1. 418, P =0. 234）. Two incomplete resection were 1 case and 3 cases, the difference had no statistical significance （X2 = 0. 455, P = 0. 500）. Non enbloc resection were 4 cases and 7 cases, the difference had no statistical significance （X2 = 0. 837, P = 0. 360）. The difficult operating group was much more than the time spent ease of operation group, the average times were （44.8 ± 9.7） minutes and （78.3 ±15.5） minutes. Conclusion It is diffi-cult to operate ESD in esophagus, cardia, colon and so on, but by improving the technical level of the doctor and by willing to spend more time, the surgical success rate and complication rate can be consistent with the ease of operati