内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效分析  

Effectiveness of endoscopic submucosal dissection vs gastrectomy for early gastric cancer and precancerous lesions

作　　者：周平红[1] 彭贵勇[2] 杨仕明[3] 陈东风[4] 李延青[5] 张昊翔[2] 房殿春[2] 姚礼庆[1] 

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032 [2]第三军医大学西南医院全军消化病研究所,重庆400038 [3]第三军医大学新桥医院消化内科,重庆400037 [4]第三军医大学大坪医院野战外科研究所消化内科,重庆400042 [5]山东大学齐鲁医院消化内科,济南250012

出　　处：《第三军医大学学报》2014年第14期1507-1511,共5页Journal of Third Military Medical University

摘　　要：目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌及癌前病变的价值。方法对2006年6月至2013年12月复旦大学附属中山医院、山东大学齐鲁医院和第三军医大学西南医院、新桥医院和大坪医院经ESD治疗的3 668例早期胃癌及癌前病变的临床病历资料进行分析,并与同期经外科手术切除的124例早期胃癌的临床病历资料,包括病理诊断、手术时间、住院时间和3年存活率进行比较。结果经ESD治疗3 668例患者一次性整块切除率为100%,一次性完整切除率为99.0%,组织学完整治愈率为99.0%。术后出血和穿孔的发生率分别为1.74%和0.76%。术后复发率为0.04%,3年生存率为99.8%。无与ESD手术相关死亡发生。早期胃癌经外科手术切除组手术时间显著长于ESD治疗组(P<0.01),术后出血和狭窄的发生率显著高于ESD治疗组(P<0.01)、住院时间亦显著长于ESD治疗组(P<0.01)。ESD组的3年存活率为99.8%,外科手术组为98.4%,两组3年存活率无显著差别(P>0.05)。结论 ESD治疗早期胃癌及癌前病变的疗效与外科手术相似,更具有手术时间短、并发症少、住院时间短等优势。Objective To examine the safety and efficacy of endoscopic submucosal dissection（ESD）for early gastric cancer（EGC） and its precancerous lesions,and to compare effectiveness of ESD versus gastrectomy for treatment of EGC.Methods We performed a retrospective cohort study including 3 668 cases of EGC or dysplasia treated by ESD at 5 hospitals（Zhongshan Hospital,Fudan University;Southwest Hospital,Xinqiao Hospital and Daping Hospital,Third Military Medical University;and Qilu Hospital,Shandong University） from 2006 to 2013.One hundred and twenty-four cases of EGC treated by gastrectomy were also included in this study.Clinical outcomes including pathology,postoperative complication,and hospital stay,as well as 3-year survival were compared.Results From 2006 to 2013,3 668 patients with dysplasia or EGC were treated by ESD.The overall en bloc resection rate was 100%,the complete resection rate 99.0% and the histologically complete resection rate 99.0%.The incidence of perforation and postoperative bleeding was 0.76 % and 1.74%,respectively.Local recurrence rate was 0.04% and the post-treatment 3-year survival was 99.8%.There were no death cases related to ESD.Patients with EGC treated by gastrectomy had longer operative time（P 0.01）,median hospital stay（P 0.01） and higher complication rate（P 0.01）.The 3-year survival rate was 99.8% for ESD and 98.4% for gastrectomy group（P 0.05）.Conclusion ESD can be considered an effective,safe and minimally invasive method to deal with EGC and its precancerous lesions,which has similar clinical outcomes with radical gastrectomy for treatment of EGC.Patients receiving ESD have better perioperative outcomes in terms of operative time,complication,and hospital stay.

关 键 词：早期胃癌 癌前病变 内镜黏膜下切除术 外科手术切除 

分 类 号：R573[医药卫生—消化系统] R730.56[医药卫生—内科学]