内镜黏膜下剥离术治疗老年单发早期胃癌的疗效分析  

Efficacy of endoscopic submucosal dissection in elderly patients with early gastric cancer

作　　者：李士杰[1] 王警[1] 李子禹[2] 步召德[2] 苏向前[2] 孙利[3] 吴齐[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所 恶性肿瘤发病机制及转化研究教育部重点实验室内镜中心,100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所 恶性肿瘤发病机制及转化研究教育部重点实验室胃肠肿瘤中心,100142 [3]北京大学肿瘤医院暨北京市肿瘤防治研究所 恶性肿瘤发病机制及转化研究教育部重点实验室病理科,100142

出　　处：《中华消化外科杂志》2016年第3期253-256,共4页Chinese Journal of Digestive Surgery

基　　金：北京市科委重大项目（D141100000414003）

摘　　要：目的探讨内镜黏膜下剥离术（ESD）治疗老年（年龄≥65岁）单发早期胃癌患者的安全性和有效性。方法采用回顾性队列研究方法。收集2011年1月至2014年6月北京大学肿瘤医院收治的145例行ESD的单发早期胃癌患者的临床资料。57例年龄／〉65岁的患者，设为老年组；88例年龄〈65岁的患者，设为中青年组。所有患者术前经多学科团队讨论、评估后决定行ESD。观察指标：手术时间、术中出血量、术后住院时间、并发症发生情况、切除标本完整性、切缘阴性、肿瘤治愈性、随访结果（患者生存情况和肿瘤复发及转移情况）。采用门诊和电话方式进行随访，了解患者生存、肿瘤复发、转移情况。随访时间截至2015年6月。正态分布的计量资料以x±s表示，组间比较采用独立样本t检验。偏态分布的计量资料以肘（范围）表示，组问比较采用非参数U检验。计数资料比较采用χ^2检验。结果两组患者手术时间分别为100（20—470）min和110（25—480）min，术中出血量分别为25（5～200）mL和25（5～600）mL，术后住院时间分别为5（2～10）d和4（2～29）d，并发症中术中穿孔患者分别为1例和3例，术后出血患者分别为2例和3例，切除标本完整性中整块切除分别为52例和85例，分块切除分别为5例和3例，切缘阴性分别为50例和83例，切缘阳性分别为7例和5例，肿瘤治愈性中治愈性切除分别为30例和47例，扩大的治愈性切除分别为17例和24例，非治愈性切除分别为lO例和17例，两组上述指标比较，差异均无统计学意义（U=2451．000，2183．500，2116．500，χ^2=1．544，1．018，1．210，0．142，P〉0．05）。并发症患者均经对症处理后好转。145例患者中，135例获得术后随访，随访时间为12—53个月，中位随访时间为26个月。老年组和中青年组肿瘤复发率分别为1．8％（1／57）和2．3％（2／88），�Objective To investigate the safety and efficacy of endoscopic submucosal dissection （ESD） in elderly patients （age≥ 65 years ） with early gastric cancer, Methods The retrospective cohort study was adopted. The clinical data of 145 patients with early gastric cancer who underwent ESD at the Peking University Cancer Hospital between January 2011 and June 2014 were collected. Of 145 patients, 57 （age≥65 years） were allocated into the elderly group and 88 （ age 〈 65 years ） were allocated into the non-elderly group. ESD was performed to all the patients after the multidiseiplinary discussion and evaluation. Observation indicators included operation time, volume of intraoperative blood loss, duration of hospital stay, complications, integrity of resected specimens, negative resection margin, tumor cure and follow-up （ survival, tnmnr recurrence and metastasis）. The follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis till June 2015. Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using t test. Measurement data with skewed distribution were presented as M （range） and comparison between groups was analyzed using nonparametric U test. Count data were analyzed using the chi-square test. Results Operation time, volume of intraoperative blood loss, duration of hospital stay, numbers of patients with postoperative perforation, bleeding, en bloc resection of tumor, piecemeal resection of tumor, negative resection margins, positive resection margins, curative resection, extended curative resection and non-curative resection were 100 minutes （range, 20-470 minutes）, 25 mL （range, 5-200 mL）, 5 days （range, 2-10 days） , 1, 2, 52, 5, 50, 7, 30, 17, 10 in the elderly group and 110 minutes （range, 25- 480 minutes）, 25 mL （range, 5-600 mL）, 4 days （range, 2-29 days）, 3, 3, 85, 3, 83, 5,47, 24, 17 in the non-elderly group, respect

关 键 词：胃肿瘤 内镜黏膜下剥离术 老年 并发症 治疗效果 

分 类 号：R735.2[医药卫生—肿瘤]