长节段早期食管癌及癌前病变内镜治疗的有效性及安全性评价  

Efficiency and safety of endoscopic therapy for early esophageal cancer and precancerous lesions with length more than 5 cm

作　　者：陈洋洋[1] 陈雅华[2] 钟世顺[1] 黄新香 兰世迁[3] 郭建民 黄子成[5] 李彩苹[6] 林吟 梁玮[1] Chen Yangyang;Chen Yahua;Zhong Shishun;Huang Xinxiang;Lan Shiqian;Guo Jianmin;Huang Zicheng;Li Caiping;Lin Yin;Liang Wei(Department of Digestive Endoscopy,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院消化内镜中心,福州350001 [2]莆田学院附属医院消化内科 [3]福建省龙岩市第一医院内镜室 [4]福建省莆田涵江医院消化内科 [5]福建省泉州市第一医院消化内科 [6]福建医科大学附属第二医院消化内科 [7]福建省福鼎市医院消化内科

出　　处：《中华消化内镜杂志》2018年第11期842-846,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家重点研发计划（2016YFC1302800）

摘　　要：目的探讨病灶长度超过5 cm的早期食管癌及癌前病变行内镜黏膜下剥离术（ESD）与内镜分片黏膜切除术（EPMR）的疗效及安全性。 方法回顾性分析2012年1月至2017年7月在福建省食管癌早诊早治促进联盟治疗的85例病灶长度超过5 cm的早期食管癌及癌前病变患者临床资料。根据术式不同，分为ESD组（52例）及EPMR组（33例），对比两组疗效、并发症及随访情况。 结果ESD组与EPMR组的完整切除率相比差异无统计学意义[86.5%（45/52）比87.9%（29/33），P〉0.05]，ESD组的手术时间[（58.53±30.50）min比（32.06±9.12）min]、术后禁食时间[（4.18±1.30）d比（3.67±0.96）d]、住院时间[（7.45±2.44）d比（6.54±1.73）d]及抗生素使用时间[（3.48±2.33）d比（1.96±2.20）d]明显长于EPMR组（P均〈0.05）。ESD组与EPMR组的术中并发症发生率比较差异无统计学意义（P〉0.05）；发热、胸痛、术后出血等近期术后并发症发生率对比差异亦无统计学意义（P〉0.05）。ESD组术后狭窄发生率较EPMR组高[23.1%（12/52）比6.1%（2/33），P〈0.05]。术后随访3～63个月，ESD组复发5例，EPMR组1例，两者对比差异无统计学意义（P〉0.05）。 结论EPMR与ESD治疗病灶长度超过5 cm的早期食管癌及癌前病变具有相同的有效性及安全性，而EPMR操作时间短，术后狭窄并发症少，且术式相对简单，易于掌握。ObjectiveTo compare the effectiveness and safety of endoscopic submucosal dissection （ESD） with endoscopic piecemeal mucosal resection （EPMR） for early esophageal cancer and precancerous lesions with length more than 5 cm. MethodsA retrospective analysis was performed on data of 85 patients diagnosed as early esophageal cancer and precancerous lesions with length more than 5 cm in Fujian Medical Association of Early Esophageal Carcinoma from January 2012 to July 2017. The patients were divided into ESD group （52 cases） and EPMR group （33 cases）, and the effectiveness and safety between the two groups were compared. ResultsThere was no significant difference on the complete resection rate between the two groups[86.5% （45/52） VS 87.9% （29/33）, P〉0.05]. The operative time （58.53±30.50 min VS 32.06±9.12 min）, postoperative fasting time （4.18±1.30 d VS 3.67±0.96 d）, postoperative hospital-stay time （7.45±2.44 d VS 6.54±1.73 d）, and postoperative antibiotics using time （3.48±2.33 d VS 1.96±2.20 d） in ESD group were higher than those in EPMR group （all P〈0.05）. There were no significant difference in the rate of intraoperative complication and short-term postoperative complication, such as fever, chest pain, and postoperative bleeding, between the two groups （all P〉0.05）. But the postoperative stricture rate of ESD group was higher than that of EPMR group[23.1% （12/52） VS 6.1% （2/33）, P〈0.05]. During the follow-up of 3-63 months, 5 cases recurred in ESD group and 1 case in EPMR group, with no significant difference （P〉0.05）. ConclusionESD and EPMR have equivalent efficacy and safety on the treatment of early esophageal cancer and precancerous lesion. EPMR has a shorter operative time, lower rate of post-operative stricture, and is easier to master.

关 键 词：食管肿瘤 内镜分片黏膜切除术 内镜黏膜下剥离术 疗效 安全性 

分 类 号：R735.1[医药卫生—肿瘤]