内镜隧道式黏膜下剥离术治疗大面积早期食管癌的安全性和有效性评价

目的评价内镜隧道式黏膜下剥离术(endoscopic submucosal tunnel dissection，ESTD)用于治疗大面积早期食管癌的安全性和有效性。 方法回顾性分析2018年1月至2019年8月于解放军总医院第一医学中心消化内科接受内镜下手术治疗的共68例大面积早期食管癌患者资料，根据手术方式不同，分为内镜下黏膜剥离术(endoscopic submucosal dissection，ESD)组45例和ESTD组23例。对比分析ESD组与ESTD组在术中出血、穿孔、剥离速度、治愈性切除率的表现。 结果安全性，ESD组1例(2.2%)术后出现迟发性出血，ESTD组2例(8.7%)发生迟发性出血，该3例出血患者通过热止血钳电凝处理均成功止血，两组相比，差异无统计学意义(P＝0.545)。ESD组无穿孔出现；ESTD组1例发生术中穿孔，以钛夹及生物蛋白胶有效封堵穿孔，两组相比，差异无统计学意义(P＝0.730)。有效性，ESD组40例(88.9%)实现治愈性切除，ESTD组21例(91.3%)达到治愈性切除，两组相比，差异无统计学意义(P＝1.000)。ESD组病变剥离速度为(33.2±13.4)mm²/min，ESTD组病变剥离速度为(41.8±17.3)mm²/min，两组相比，ESTD组要显著快于ESD组(P＝0.027)。 结论与传统ESD相比，ESTD对于病变黏膜剥离速度更快，是一种安全有效的治疗大面积早期食管癌的内镜下切除术式。

Safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer

ObjectiveTo evaluate the safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer. MethodsA total of 68 patients with large early esophageal cancer accepted endoscopic submucosal dissection (ESD) or endoscopic submucosal tunnel dissection (ESTD) in our center from Jan. 2018 to Aug. 2019. Based on the operation strategy, 45 patients underwent ESD and 23 patients underwent ESTD treatment. Hemorrhage, perforation, dissection speed, curative resection rate and relative clinical date of ESD and ESTD group were collected and analyzed. ResultsDelayed bleeding occurred in 1 patient (2.2%) of ESD group. There was no significant difference compared with 2 patients (8.7%) of ESTD group (P=0.545). Hemostatic forceps were used to manage bleeding successfully. No perforation was observed in ESD group and intraoperative perforation occurred in 1 patient of ESTD group. No significant difference was observed between two groups (P=0.730). The perforation was treated with fibrin sealant and tissue forceps. 40 patients (88.9%) achieved curative resection and there was no significant difference compared with 21 patients(91.3%) of ESTD group (P=1.000). The dissection speed of ESTD was significantly quicker than that of ESD group(41.8±17.3)mm²/min vs (33.2±13.4)mm²/min(P=0.027). ConclusionsESTD appeared to be comparable with ESD in terms of safety and effficacy for large esophageal cancer. Besides, ESTD could provide a quicker dissection speed.