内镜分片黏膜切除术与黏膜下剥离术治疗直径大于15mm食管黏膜病变的对比研究  

Comparison of endoscopic piecemeal mucosal resection and endoscopic submucosal dissection for treatment of esophageal mucosal lesion larger than 15 mm

作　　者：何梦江[1] 李全林[1] 陈巍峰[1] 张轶群[1] 钟芸诗[1] 马丽黎[1] 徐美东[1] 周平红[1] 

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2017年第6期389-393,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海市卫生局青年科研项目（20124Y129）

摘　　要：目的评价内镜分片黏膜切除术（EPMR）及内镜黏膜下剥离术（ESD）治疗直径≥15mm食管黏膜病变的临床价值。方法2009年9月至2011年8月，在复旦大学附属中山医院内镜中心接受ESD治疗（ESD组，n=198）或EPMR治疗（EPMR组，n=63）的直径≥15mm的食管黏膜病变患者纳入回顾性分析，对比观察2组治疗效果、并发症和局部复发情况。结果ESD组的病灶大小明显大于EPMR组[（3．02±1．13）mm比（2．66±0．95）mm，P〈0．05]，ESD组的整块切除率、完整切除率和治愈性切除率分别为100％（198／198）、96％（190／198）和94％（187／198），EPMR组只有水平切缘能够得到病理学评估（其中2例水平切缘阳性）。近期并发症（大量出血和穿孔）方面，2组间差异无统计学意义（P〉0．05）。除外进一步接受外科手术治疗的5例患者（ESD组4例、EPMR组1例），EPMR组的术后食管狭窄率明显高于ESD组[22．6％（14／62）比6．2（12／194），P〈0．05]。除外切缘阳性的10例患者，EPMR组的局部复发率也明显高于ESD组[11．5％（7／61）比3．7％（7／190），P〈0．05]。结论对于直径≥15mm的食管黏膜病变，ESD的治疗效果优于EPMR，具有更少的局部复发，而且并发症未相应增加。Objective To evaluate the clinical value of endoscopic piecemeal mucosal resection （EPMR） and endoscopic submucosal dissection （ESD） for treatment of esophageal mucosal lesion with diameter larger than 15 ram. Methods The data of 261 patients with esophageal mucosal lesions ≥ 15 mm and undergoing ESD （ n = 198 ） or EPMR （ n = 63 ） in Endoscopy Center of Zhongshan Hospital from September 2009 to August 2011 were retrospectively analyzed. Therapeutic effect, complications, and local recurrence were compared between the two groups. Results The lesion size was significantly larger in the ESD group than that in the EPMR group （3.02±1.13 mm VS 2.66±0. 95 ram, P〈0. 05）. The rates of en bloc reseetion, complete resection, and curative resection were 100% （198/198） , 96% （190/198） , and 94% （187/198）, respectively in the ESD group. Only samples with horizontal margin obtained the pathological assessment in the EPMR group, and 2 eases were positive. The incidence of short-term complications ineluding massive bleeding and perforation was no statistically different （P〉0. 05 ） between the two groups. The rate of postoperative esophageal stricture was higher in the EPMR group than that of the ESD group [22, 6% （14/62） VS 6. 2% （12/194） ,P〈0. 05] except for 5 cases with further surgery treatment （4 cases in the ESD group and 1 case in the EPMR group）. The local recurrence rate was also higher in the EPMR group than that of the ESD group [ 11.5 % （ 7/61 ） VS 3.7% （ 7/190 ）, P〈 0.05 ], except for 10 cases with positive margin. Conclusion The therapeutic effect of ESD is superior to that of EPMR for esophageal mucosal lesions with diameter larger than 15 mm due to lower rate of local recurrence and acceptable complications.

关 键 词：内镜治疗 内镜黏膜下剥离术 内镜下分片黏膜切除术 食管肿瘤 

分 类 号：R655.4[医药卫生—外科学]