内镜下黏膜剥离术治疗早期食管癌的临床疗效和安全性评估  

The clinical effect and safety assessment of endoscopic submucosal dissection for early esophageal cancer

作　　者：鹿博[1] 吴明波[1] 周甜[1] 王艳[1] 熊轩轩[1] 张双双[1] 苏静 张海燕[1] 张娜[1] 

机构地区：[1]徐州市中心医院消化科,江苏徐州221009

出　　处：《胃肠病学和肝病学杂志》2017年第11期1278-1281,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：江苏省徐州市科技计划项目(社会发展项目)基金资助(KC14SH022);江苏省徐州市中心医院硕博团队课题(xzs2013051)

摘　　要：目的评估内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗早期食管癌的临床疗效和安全性,探讨其临床应用价值。方法回顾性分析徐州市中心医院2010年5月至2015年5月收治的146例早期食管癌患者临床资料。按照其治疗方式分为ESD组(n=70)及内镜下黏膜切除术(endoscopic mucosal resection,EMR)组(n=76),比较两组患者临床疗效、并发症、复发和生存情况。结果两组患者手术时间、住院时间、住院费用及并发症发生率比较,差异无统计学意义(P>0.05)。ESD组整块切除率、侧切缘阴性率、垂直切缘阴性率及治愈切除率分别为92.86%、85.71%、92.86%、78.57%,均显著高于EMR组的42.11%、52.63%、63.16%、52.63%,差异有统计学意义(P<0.05)。ESD组并发症发生率为28.57%,稍低于EMR组的28.95%,差异无统计学意义(χ2=0.925,P>0.05)。ESD组复发率为7.14%,显著低于EMR组的21.05%,差异有统计学意义(χ2=5.981,P<0.05)。随访期间无患者死亡。结论 ESD治疗早期食管癌可取得更高的整块切除率和组织学治愈切除率,有效降低患者复发风险,具有良好的临床疗效及安全性,建议进一步推广。Objective To evaluate the clinical effect and safety of endoscopic submucosal dissection （ESD） for ear- ly esophageal cancer, and explore its clinical value. Methods The clinical data of 146 cases of early esophageal cancer patients in Xuzhou Central Hospital from May. 2010 to May. 2015 were retrospectively analyzed. All the patients were divided into ESD group （n = 70） and endoscopic mncosal resection （EMR） group （n = 76） according treatment method. Efficacy, complications, recurrence and survival were compared. Results The operative time, hospital stay, incidence of complications and hospital costs were not statistically significant between two groups （ P 〉 0.05 ）. En-bloc resection rate, lateral margin negative rate, vertical negative margin resection rate and the cure rate in ESD group were significant- ly higher than those in EMR group （P 〈 0.05）. There was not statistically significant in complication rate between two groups （X2 = 0. 925, P 〉 0.05）. The recurrence rate in ESD group was significant lower than that in EMR group （x2 = 5. 981, P 〈 O. 05）. No patient died during the follow-up period. Conclusion ESD treatment on early esophageal canc- er can achieve a higher rate of en-bloc resection and histological cure rate, effectively reducing the risk of recurrence in patients with good clinical efficacy and safety, it is recommended to further promote.

关 键 词：内镜下黏膜剥离术 内镜下黏膜切除术 早期食管癌 临床疗效 安全性 

分 类 号：R735.1[医药卫生—肿瘤]