内镜下黏膜切除术对早期食管癌疗效的评估  

The effect of endoscopic mucosal resection for early esophageal cancer

作　　者：周晓[1] 王拥军[1] 于中麟[1] 李鹏[1] 张澍田[1] 

机构地区：[1]首都医科大学附属北京友谊医院消化科国家消化系统疾病临床医学研究中心北京市消化疾病中心消化疾病癌前病变北京市重点实验室,北京100050

出　　处：《中国医刊》2015年第9期36-40,共5页Chinese Journal of Medicine

基　　金：北京市科委"首都市民健康项目培育"专项;首都卫生发展科研专项项目(首发2014-1-2021);首都临床特色应用研究(Z121107001012001)

摘　　要：目的分析内镜下黏膜切除术(endoscopic mucosal resection,EMR)对早期食管癌的治疗疗效,与外科手术效果对比,评价EMR的有效性、安全性及可行性。方法对北京友谊医院消化内镜中心2007年1月至2013年10月行EMR术或外科手术并经病理证实为早期食管癌的病例进行回顾性分析,将两组病例进行安全性及有效性对比,分析其生存率,评估EMR的可行性及安全性。结果接受内镜EMR或外科手术治疗,术后病理证实诊断为早期食管癌患者共71例。接受EMR治疗患者共47例,其中6例接受2次EMR,3例接受3次EMR,5例接受4次EMR,1例接受5次EMR治疗;接受外科手术共24例。EMR多采用圈套器法及透明帽法,多次切除,术前黏膜下注射,抬举征阳性者切除。与外科手术组对比,EMR组操作时间、住院时间及住院花费均明显低于外科手术组。EMR术后并发症主要为穿孔1.28%(1/78),感染5.13%(4/78),切缘残留10.26%(8/78),食管狭窄5.13%(4/78)。首次EMR术后原位复发率为8.89%(4/45),食管癌新发率为11.11%(5/45)。EMR术后平均生存时间为(5.47±0.14)年。EMR组及外科手术组两组生存曲线整体Log-Rank检验结果为P=0.187,两组差异无显著性。结论早期食管癌患者应用EMR治疗安全有效,可行性高,建议在临床工作中广泛开展。Objective To analyze the effectiveness,safety and feasibility of endoscopic mucosal resection（ EMR） for early esophageal cancer therapy. Method Early esophageal cancer patients confirmed by pathology treated by EMR were analyzed retrospectively in Beijing Friendship Hospital Digestive Endoscopy Center from January 2007 to October 2013. Comparing efficacy of EMR group and surgical group,analyze their survival to assess the feasibility and safety of EMR. Result There was a total of 71 patients with early esophageal cancer accepted endoscopic EMR or surgical treatment confirmed by postoperative pathologic diagnosis in Beijing Friendship Hospital from January 2007 to October 2013. 47 patients accepted EMR therapy,six of whom received two times EMR,3 received three times EMR,5 accepted four times EMR,1 received five EMR therapies. While a total of 24 patients underwent surgery. Our hospital usually use snare or transparent cap method,repeated resection,preoperative submucosal injections,undergoing resection for lifting sign positive. The operating time, hospital stay and hospitalization costs of the EMR group were significantly lower than the surgical group. Post-EMR complications included perforation of 1. 28%（1/78）,infection of 5. 13%（4/78）,the edge residual of 10. 26%（8/78）,esophageal stricture of 5. 13%（4/78）, operation failure of 1. 28%（1/78）. Post-first EMR recurrence rate is 8. 89%（4/45）. The average survival time post-EMR was （5. 47＆#177;0. 14） years. To analyze the two sets of survival curves of the EMR group and surgical group the Log-Rank test results（P=0. 187）,there was no statistically significant difference between the two groups. Conclusion EMR therapy for early esophageal cancer patients is safe and effective,feasible,which is recommended for extensive clinical practice.

关 键 词：早期食管癌 内镜下黏膜切除术 临床疗效 手术治疗 

分 类 号：R571[医药卫生—消化系统]