早期大肠癌内镜治疗的临床评价  

Clinical Evaluation of Treatment on Early Stage Colorectal Cancer by Endoscopic Resection

作　　者：张英辉[1] 盛剑秋[1] 晨智敏[1] 闫伟[1] 余东亮[1] 李爱琴[1] 王海红[1] 韩英[1] 李世荣[1] 

机构地区：[1]北京军区总医院消化内科,100700

出　　处：《胃肠病学》2007年第1期5-8,共4页Chinese Journal of Gastroenterology

基　　金：北京市科学技术委员会基金资助项目(No.H020220020610);北京市自然科学基金项目(No.7062064)资助

摘　　要：背景:早期大肠癌可以采用内镜下切除治疗,但其疗效和预后仍是人们普遍关心的问题。目的:评价内镜治疗早期大肠癌的疗效和预后。方法:对1986年1月～2005年10月经内镜确诊的早期大肠癌患者,按治疗方法的不同分为内镜治疗组和外科手术治疗组,对两组的临床资料、治疗方法和随访结果进行回顾性分析。结果:99例早期大肠癌(104个癌灶)中,无症状人群普查发现34例,临床就诊发现65例。内镜治疗69例(共72个癌灶),外科手术治疗30例(包括内镜治疗后追加手术者,共32个癌灶)。内镜治疗组癌灶完全切除率为97.5%,无严重并发症发生。外科手术治疗组有1例病理证实癌组织浸润达黏膜下深层,肝脏有多个微结节转移灶。内镜治疗组经3个月～19年的随访,除19例失访、6例死于心脏病等疾病外,无一例肿瘤复发。比较两组黏膜和黏膜下层早期大肠癌的临床资料、随访结果和5年生存率,内镜治疗组的疗效与手术治疗组相似(P>0.05)。结论:早期大肠癌,特别是黏膜层早期大肠癌内镜治疗的疗效和随访结果与手术治疗相似,且损伤小、安全、简便。黏膜下深层癌易发生转移,内镜下切除应注意判断肿瘤黏膜浸润深度,非提起征是内镜切除的关键指征。无症状自然人群普查是发现早期大肠癌的重要途径。Background： Early stage colorectal cancer can be treated by endoscopic resection, yet its efficacy and prognosis remain to be concerned. Aims： To evaluate the efficacy and prognosis of endoscopic resection in the treatment of early stage colorectal cancer. Methods： Ninety-nine patients with early stage colorectal cancer diagnosed endoscopically from Jan. 1986 to Dec. 2005 were divided into two groups in accordance with the modality of treatment： endoscopic resection and surgical resection. Both groups of patients were retrospectively analyzed with respect to their clinical data, therapeutic modality and follow-up results. Results： Of the 99 patients with early stage colorectal cancer （104 cancerous lesions）, 34 patients were detected by mass screening of general population and 65 diagnosed at outpatient clinic. Sixty-nine patients （72 cancerous lesions） were treated by endoscopic resection, and 30 patients （32 cancerous lesions） were treated by surgical resection （including those patients with additional surgical resection after endoscopic removal of cancerous lesions）. The removal rate of cancerous lesions by endoscopic resection was 97.5% without serious complications. Pathological examination showed cancer cells infiltration in the submucosal layer and micrometastasis in the liver in a patient of the surgical resection group. Follow-up study was performed from 3 months to 19 years in the endoscopic resection group, 19 patients lost to follow-up and 6 patients died of cardiac diseases, no recurrence of cancer was observed. The five-year survival rate of these two groups indicated that the efficacy of endoscopic resection was similar to that of surgical resection （P〉O.05）. Conclusions： The efficacy of follow-up study in endoscopic resection group for early stage colorectal cancer, especially the early mucosal colorectal cancer, is similar to that in surgical resection group. The advantages of endoscopic resection of early stage colorectal cancer are safety and fewer traumas. Dee

关 键 词：结直肠肿瘤 早期诊断 治疗 临床试验 

分 类 号：R735.34[医药卫生—肿瘤]