早期食管癌内镜治疗与外科手术疗效对比研究  

A Comparison Between Endoscopic Therapy and Open Surgical Resection for Early Esophageal Cancer

作　　者：武育卫[1] 彭贵勇[1] 龙庆林[1] 陈磊[1] 赵晶京[1] 李向红[1] 

机构地区：[1]第三军医大学西南医院全军消化病研究所,重庆400038

出　　处：《中国肿瘤》2009年第9期756-758,共3页China Cancer

基　　金：重庆市科技攻关课题(2008AC5003)

摘　　要：[目的]比较早期食管癌内镜治疗与外科手术的治疗效果。[方法]101例早期食管癌患者分为内镜治疗组和外科手术组,内镜下黏膜切除术(EMR)30例共32个病灶,内镜黏膜下剥离术(ESD)4例,外科手术67例共68个病灶。比较内镜治疗与外科手术的治疗效果。[结果]内镜EMR术后病理:31个病灶完全切除,切除成功率为96.9%(31/32);内镜ESD术后病理:4个病灶均完全剥离,剥离成功率为100.0%。在随访期间内,内镜治疗组复发3例,复发率为8.8%(3/34),死亡2例,死亡率为5.9%(2/34),总生存率为94.1%(32/34),术后3、4、5年生存率分别是93.8%(15/16)、84.6%(11/13)和75.0%(6/8)。外科手术组死亡2例,死亡率为3.0%(2/67),总生存率为97.0%(65/67),术后3、4、5年生存率分别是96.8%(30/31)、90.0%(18/20)和81.8%(9/11)。两组患者术后总生存率及3、4、5年生存率无明显差异(P>0.05)。[结论]早期食管癌内镜治疗与外科手术治疗效果相似。对无淋巴结转移的黏膜内癌,内镜EMR、ESD治疗有效,可代替外科手术。[Purpose ] To compare the therapeutic result of endoscopic therapy and open surgical resection for early esophageal cancer. [Method] One hundred and one cases with early stage esophageal cancer were divided into endoscopic therapy group and open surgical resection group, with endoscopic mucosal resection（EMR） in 30 cases （32 lesions）, endoscopic submucosal dissec- tion（ESD） 4 cases, and open surgical resection, 67 cases （68 lesions）. The result of endoscopic therapy and open surgical resection were compared. [Results ] Postoperative pathology showed that 31 lesions were completely resccted with EMR, the resection rate was 96.9%（31/32）, and 4 lesions were completely resected with ESD, the overall resection rate was 100.0%. During follow-up period, 3 cases recurred in endoscopic therapy group with recurrence rate 8.8%（3/34）, and 2 cases died with death rate 5.9%（2/34）, the overall and 3-, 4-, 5-year survival rate were 94.1~/o（32/34）,93.8% （15/16）, 84.6% （11/13）, 75.0% （6/8） respectively in endoscopic therapy group. In open surgical resection group 2 cases died with death rate 3.0%（2/67）; the overall and 3-, 4-, 5-year survival rate were 97.0%（65/67）, 96.8% （30/31）, 90.0%（18/20）, 81.8%（9/11 ） respectively. The overall and 3-, 4-, 5-year survival rate were not statistically different between the two groups （P〉0.05）. [Conclu- sion] The therapeutic result between endoscopic therapy and open surgical resection for early esophageal cancer is similar, and EMR or ESD can replace open surgical resection for mucosal cancer without lymphoid node metastasis.

关 键 词：食管肿瘤 内镜下黏膜切除术 内镜黏膜下剥离术 外科手术 治疗效果 

分 类 号：R735.1[医药卫生—肿瘤]