内镜黏膜下剥离术治疗胃黏膜病变的长期疗效研究  

Long-term effects of endoscopic submucosal dissection upon gastric mucosal lesions

作　　者：张波[1,2] 令狐恩强[1] 柴宁莉[1] 卢忠生[1] 杨竞[1] 陈亚东[2] 冯秀雪 宋丹丹[1] 杜红[1] 孟江云[1] 王红斌[1] 王向东[1] 朱静[1] 唐平[1] 

机构地区：[1]解放军总医院消化科,北京100853 [2]中共中央办公厅警卫局保健处,北京100017

出　　处：《中华胃肠内镜电子杂志》2017年第3期97-102,共6页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：北京市科委项目(D141100000414003)

摘　　要：目的评价内镜黏膜下剥离术(ESD)治疗胃高级别上皮内瘤变(HGIN)及早期胃癌(EGC)的长期疗效。方法回顾性分析2006年11月至2016年1月经解放军总医院消化内镜中心ESD治疗的术后病理诊断为HGIN及EGC的444例患者,对其生存状况进行随访,并结合临床病理进行总结,分析评价ESD疗效,包括:完全切除率、治愈性切除率、生存率、并发症及复发率。结果经ESD治疗的444例患者共切除病变451个,其中黏膜内癌52个(11.5%)、黏膜下癌25个(5.5%)、HGIN 374个(82.9%)。整块切除率为94.5%(426/451)、完全切除率为88.9%(401/451)、治愈性切除率为87.1%(393/451)。术中微小穿孔1例(0.2%),金属夹夹闭治愈;术后迟发性出血11例(2.3%),10例内镜下止血成功、1例内镜止血失败转外科手术治愈。术后幽门狭窄2例(0.5%),均经扩张治疗好转。444例患者中,410例患者获得随访,随访率为92.3%,随访时间平均56个月(18~109个月)。总复发率为2.9%(13/451)。随访期间死亡5例,总生存率为98.9%(439/444)。结论ESD治疗EGC具有较高的治愈率及较低的并发症发生率,长期疗效肯定。Objective To evaluate the long-term effects of endoscopic submucosal dissection（ESD）upon early gastric cancer（ EGC）. Methods To summarize the clinical pathology and follow-up data on 444 patients diagnosed with EGC who received ESD in Digestive Endoscopy Center in Chinese PLA General Hospital from November 2006 to January 2016. The primary indicators were complete resection rate,curative resection rate and survival rate,the secondary indicators were complications and recurrence rate. Results Among 444 patients treated by ESD,451 lesions were resected including 52 intramucosal carcinoma（11. 5%）,25 submucosal cancer（5.5%） and 374 high-grade intraepithelial neoplasia（82. 9%）. The en bloc resection rate,complete resection rate and curative resection rate by ESD were 94. 5%（426/451）,88. 9%（401/451）,and 87. 1%（393/451）respectively. The rate of micro-perforation during operation（10 cured by emergency endoscopy hemostasis and1 cured by endoscopic hemoclipping） was 0. 2%. The rate of delayed bleeding after operation（cured by surgical operation after emergency endoscopic hemostasis failure） was 2. 3%. The follow-up visits were paid to 410 patients among 444 patients after ESD at the rate of 92. 3% in median 56 months（18-109 months）,which showed that the total recurrence rate was 2. 9%. The total survival rate was 98. 9%（439/444）. Conclusions There were high curative rate and low compucation rate for EGC patients undergoing ESD and the long-term effects were satisfying.

关 键 词：胃黏膜病变 内镜黏膜下剥离术 高级别上皮内瘤变 

分 类 号：R735.2[医药卫生—肿瘤]