内镜黏膜下剥离术在早期胃癌及癌前病变治疗中的价值

发布时间：2018-11-01 21:20

【摘要】：目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌及癌前病变的安全性、有效性,为早期胃癌及癌前病变的内镜治疗提供依据。方法回顾性分析2012年10月到2014年8月在第二军医大学长海医院消化内镜中心接受ESD治疗的214例胃黏膜病变患者的临床资料,分析术前评估、病理特征、ESD治疗及术后随访等情况。结果214例患者术前评估中,接受内镜窄带成像(narrow band imaging,NBI)检查者67例(31.3%),NBI联合放大内镜(magnifying endoscopy,ME)检查者39例(18.2%),超声内镜(endoscopic ultrasonography,EUS)检查者50例(23.4%),CT检查者50例(23.4%),活组织检查者192例(89.7%)。214例病灶术后病理中,低级别上皮内瘤变84例(39.2%)、高级别上皮内瘤变55例(25.7%)、高分化癌45例(21.0%)、中分化癌19例(8.9%)、低分化癌11例(5.1%)。ESD整块切除率为96.3%,完整切除率为92.1%;ESD手术时间为14~290min,平均(59.9±49.6)min;术中大出血2例(0.9%),术中穿孔2例(0.9%);术后延迟出血5例(2.3%),术后复发5例(2.3%),无患者发生术后延迟性穿孔。结论 ESD是治疗早期胃癌及癌前病变的有效手段,但应进行完善的术前评估以避免不必要或过度的ESD治疗,术后定期随访是监测术后病灶残留与复发的有效手段。
[Abstract]:Objective to evaluate the safety and efficacy of endoscopic submucosal dissection (endoscopic submucosal dissection,ESD) in the treatment of early gastric cancer and precancerous lesions, and to provide evidence for endoscopic treatment of early gastric cancer and precancerous lesions. Methods the clinical data of 214 patients with gastric mucosal lesions treated with ESD from October 2012 to August 2014 in Changhai Hospital of second military Medical University were analyzed retrospectively. ESD treatment and postoperative follow-up. Results Sixty-seven patients (31.3%) underwent endoscopic narrow-band imaging (narrow band imaging,NBI) and 39 (18.2%) underwent endoscopic), NBI combined with magnifying endoscopy (magnifying endoscopy,ME). Endoscopic (endoscopic ultrasonography, (EUS) was performed in 39 patients (18.2%). EUS was examined in 50 cases (23.4%) by), CT, and by biopsy in 192 cases (89.7%). 84 cases (39.2%) had low grade intraepithelial neoplasia. There were 55 cases (25.7%) of high grade intraepithelial neoplasia, 45 cases (21.0%) of well-differentiated carcinoma, 19 cases (8.9%) of moderately differentiated carcinoma, 11 cases (5.1%) of poorly differentiated carcinoma (9.63%). The complete resection rate was 92.1%; The mean operation time of ESD was (59.9 卤49.6) min; in 2 cases (0.9%) and perforation in 2 cases (0.9%). Delayed hemorrhage occurred in 5 cases (2.3%) and recurrence in 5 cases (2.3%). Conclusion ESD is an effective method for the treatment of early gastric cancer and precancerous lesions, but it should be evaluated before operation to avoid unnecessary or excessive ESD therapy.
【作者单位】：第二军医大学长海医院消化内镜中心;
【分类号】：R735.2

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