内镜黏膜下剥离术治疗胃癌前病变及早期癌的三年疗效评价  

Three years clinical value of precancerous lesions and early gastric cancer after endoscopic submucosal dissection

作　　者：刘靖正[1] 徐美东[1] 姚礼庆[1] 周平红[1] 陈巍峰[1] 秦文政[1] 胡健卫[1] 

机构地区：[1]复旦大学附属中山医院内镜中心复旦大学内镜诊疗研究所,上海200032

出　　处：《中华临床医师杂志（电子版）》2012年第21期6672-6677,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市卫生局科研课题(2010050);国家自然科学基金(11071046)

摘　　要：目的评价内镜黏膜下剥离术(ESD)治疗胃癌前病变和早期癌的远期疗效。方法对2006年6月至2009年6月在复旦大学附属中山医院内镜中心经ESD治疗的153例早期胃癌和癌前病变患者的临床病理和随访资料进行总结,分析ESD治疗的一次性完整切除率、并发症发生率和远期疗效。结果 153例患者中包括早期胃癌26例(17%),高级别上皮内瘤变67例(43.8%),低级别上皮内瘤变60例(39.2%);ESD一次性整块切除率为98.0%(150/153),一次性完整切除率为94.8%(145/153),组织学完整治愈率为94.8%(145/153)。术中穿孔5例(3.3%),术后迟发性出血9例(5.9%),均予保守治疗治愈;ESD术后3年内病变复发3例,总复发率为2.1%(3/140);140例患者获得随访,随访率为91.5%,随访时间11～54(35.1±22.8)个月;死亡1例,3年生存率为99.3%(152/153)。结论 ESD治疗胃癌前病变和早期癌是一种安全、远期疗效肯定的方法,值得推广。Objective To evaluate the three years clinical value of precancerous lesions and early gastric cancer after endoscopic submucosal dissection(ESD).Methods The follow-up endoscopy was performed in 153 patients with early gastric cancer and precancerous lesions who underwent ESD from June 2006 to June 2009.The whole piece of dissection rate of one-time,complications and long-term surial were analysis of all the patients.Results A total of 153 patients were recruited into the present study,including early gastric cancer 26 cases(17%),high-grade intraepithelial neoplasia 67 cases(43.8%),and low-grade intraepithelial neoplasia 60 cases(39.2%).ESD whole piece of dissection rate of one-time was 98.0%(150/153),complete excision rate of one-time was 94.8%(145/153);the histologically complete resection rate was 94.8%(145/153).The perforation rate was 3.3%(5/153),the delayed bleeding rate was 5.9%(9/153).After three years the recurrence rate was 2.1%(3/140).The patients had a follow-up period of 11 to 54(35.1±22.8)months,with a loss of 13 patients and 1 patient died.The three years survival rate was 99.3%(152/153).Conclusions ESD is an effective,safe,and minimally invasive method to deal with precancerous lesions and early gastric cancer.

关 键 词：胃肿瘤 癌前状态 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]