内镜黏膜下剥离术治疗胃食管早癌的疗效及相关影响因素分析

发布时间：2018-03-26 10:54

  本文选题：内镜黏膜下剥离术　切入点：早期胃癌　出处：《浙江大学》2017年硕士论文

【摘要】：背景:当前我国人民对健康筛查的重视不断提高,而内镜设备的更新换代,使早期胃癌及早期食管癌的检出率逐步提高。早诊断和早治疗使患者极大获益,显著提高了生存期及生存质量。既往外科手术是胃癌及食管癌的首选治疗方式,近年来内镜治疗在早期胃癌及食管癌的治疗领域已得到较大的发展。内镜黏膜下剥离术(ESD)作为消化道早癌的一种治疗手段,已在国内广泛开展。而内镜黏膜下剥离术对治疗消化道早癌的疗效及影响因素有待继续探索和验证。本文旨在统计分析及报道本中心近5年的研究成果,以期进一步明确内镜黏膜下剥离术治疗早期胃癌及早期食管癌的疗效及其相关影响因素,为临床医师的决策制定提供理论依据。方法:本研究回顾下分析了于浙江大学医学院附属第一医院消化内科行ESD术的120例早期胃癌患者及30例早期食管癌患者的疗效及相关影响因素。应用Cox回归模型进行生存分析,而生存曲线以Kaplan-Meier方法绘制。采用卡方检验或Fisher精确概率法评估切缘情况与其他临床及病理特征之间的关联性。结果:本研究结果显示ESD治疗早期胃癌的手术并发症发生率为9.2%,切缘阳性率为5.8%,术后平均住院日约7.6天,术后的3年及5年总体生存率分别为97.5%和94.1%,同时3年及5年无复发生存率分别为95.2%和77.7%。生存分析提示性别、老年情况、肿瘤分化程度、浸润深度、并发症情况等均不影响患者的总体生存率及无复发生存率(P≥0.05)。而切缘阳性的患者更容易复发,是患者复发的独立影响因素(HR=6.05,95%CI:1.39-26.29;P=0.016)。进一步探索发现,切缘阳性与浸润深度及超声内镜检查相关(OR=17.5;95%CI:3.32-92.09;OR=1.66;95%CI:1.43-1.93)。另一方面,我们的研究结果显示:ESD治疗早期食管癌的手术并发症发生率为13.3%,切缘阳性率为10.0%,术后平均住院日约9.5天,亦提示ESD是治疗早期食管癌的有效治疗手段。结论:本研究发现,ESD是治疗早期胃癌及早期食管癌有效且安全可靠的治疗方式。ESD具有创伤小、并发症少、住院时间短等优点。切缘阳性是早期胃癌ESD术后复发的独立影响因素,术前的超声内镜检查有利于进一步明确病灶侵犯层数,从而优化病例筛选,减少切缘的阳性率。
[Abstract]:Background: at present, people in our country pay more and more attention to health screening, and the rate of detection of early gastric cancer and early esophageal cancer is gradually increased with the replacement of endoscopic equipment. Early diagnosis and early treatment greatly benefit patients. The survival time and quality of life were significantly improved. Surgical treatment was the first choice of treatment for gastric cancer and esophageal carcinoma. In recent years, endoscopic therapy has been developed in the field of early gastric cancer and esophageal cancer. Endoscopic submucosal dissection (ESD) is a treatment for early gastrointestinal cancer. The therapeutic effect of endoscopic submucosal dissection on early cancer of digestive tract and its influencing factors need to be further explored and verified. The purpose of this paper is to analyze and report the results of the study in the past 5 years. To further determine the therapeutic effect of endoscopic submucosal dissection for early gastric cancer and early esophageal carcinoma and its related factors. Methods: 120 cases of early gastric cancer and 30 cases of early esophageal cancer treated with ESD in the Department of Digestive Medicine affiliated to the first Hospital of Zhejiang University Medical College were analyzed retrospectively. Cox regression model was used for survival analysis. The survival curve was plotted by Kaplan-Meier method. The correlation between cutting margin and other clinical and pathological features was evaluated by chi-square test or Fisher precise probability method. Results: the results of this study showed that ESD was used to treat early gastric cancer complicated by surgery. The incidence of symptoms was 9.2 and the positive rate of incision margin was 5.8. The average hospital stay after operation was about 7.6 days. The overall 3-year and 5-year survival rates were 97.5% and 94.1%, respectively, and the 3-year and 5-year recurrence free survival rates were 95.2% and 77.7%, respectively. The complications did not affect the overall survival rate and the recurrence free survival rate (P 鈮，

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