内镜黏膜下剥离术治疗消化道早期癌及癌前病变长期疗效的单中心回顾性队列分析  

A retrospective cohort study of the long-term effects of endoscopic submucosal dissection in treating early gastrointestinal cancer or precancerous lesions

作　　者：杜静[1] 韩勇[2] 吴伟权[1] 李鹏[1] 杨建民[1] Jing Du;Yong Han;Wei-quan Wu;Peng Li;Jian-min Yang(Department of Gastroenterology,Zhejiang Provincial People’s Hospital(People’s Hospital of Hangzhou Medical College), Hangzhou, Zhejiang 310014, China;Clinical Research Institute, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Hangzhou, Zhejiang 310014, China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)消化内科,浙江杭州310014 [2]浙江省人民医院(杭州医学院附属人民医院)临床研究所,浙江杭州310014

出　　处：《中国内镜杂志》2017年第8期13-17,共5页China Journal of Endoscopy

基　　金：浙江省科技厅面上社会发展项目(No:2009C33082);浙江省自然科学基金(No:LQ17H160016);浙江省医药卫生科技计划(No:2015KYA029)

摘　　要：目的研究内镜黏膜下剥离术(ESD)治疗消化道早癌或癌前病变的长期疗效以及术后复发的影响因素。方法收集73例患者的临床及随访资料。采用Kaplan-Meier法,Log-rank和Breslow检验,以及Cox风险比例模型进行统计学分析。结果胃和结直肠ESD术后中位无复发生存时间(DFS)大于该研究最长随访时间(65个月),食管中位生存时间为44.5个月;与胃和结直肠相比,食管ESD术后DFS明显减少(χ~2=12.61,P=0.000;χ~2=7.09,P=0.008);病灶异型程度(浸润深度)和病灶面积影响ESD术后DFS(P=0.027,OR=2.38,95%CI:1.10~5.12;P=0.074,OR=0.90,95%CI:0.80~1.01)。结论 ESD术是切除消化道早期癌和癌前病变并维持长期不复发的有效内镜下手术方法 ;异型程度(浸润深度)是影响ESD术后DFS的独立危险因素;病灶面积在影响ESD术后的DFS方面具有临床意义。Objective A retrospective cohort study was carried out to observe the long-term effect of ESDin treating early gastrointestinal cancer or precancerous lesions.Methods The clinical and follow-up data of73patients were collected.Kaplan-Meier,Log-rank and Breslow test and Cox’s proportional hazards regression modelwere used to analyze the data.Results The median survival time in the gastric and colo-rectal early cancer orprecancerous lesions is longer than65months in our study,respectively.For esophagus,the median survival time was44.5months;the disease free survival time(DFS)after ESD was significantly reduced in the esophagus,comparedto the stomach and colo-rectum(χ2=12.61,P=0.000;χ2=7.09,P=0.008);the degree of atypia(or infiltration),and lesion size were considered to be two factors to influence the DFS after ESD(P=0.027,OR^=2.38,95%CI:1.10~5.12,P=0.074,95%CI;OR^=0.90,95%CI:0.80~1.01).Conclusion ESD is an effective curative treatmentin the resection of early upper gastrointestinal cancer and precancerous lesions.The degree of atypia(or infiltration)was concluded as an independent risk factor for the DFS post-ESD,and the size of lesion was a valuable parameter with regard to the recurrence after ESD procedure.

关 键 词：内镜黏膜下剥离术 早期癌 癌前病变 消化道 

分 类 号：R735[医药卫生—肿瘤]