内镜黏膜下剥离术与内镜分片黏膜切除术治疗直径>15 mm食管黏膜病变的比较  

Endoscopic submucosal dissection versus endoscopic piecemeal mucosal resection in the treatment of esophageal mucosal lesions larger than 15 mm in diameter

作　　者：许保 陈正义[1] 黄晓曦[1] 李赛莲 许梦玫 XU Bao;CHEN Zheng-yi;HUANG Xiao-xi;LI Sai-lian;XU Meng-mei(Department of Gastroenterology, Affiliated Haikou Hospital of Xiangya Medical School of Central South University, Haikou,Hainan 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院消化内科

出　　处：《中国临床研究》2019年第9期1249-1251,共3页Chinese Journal of Clinical Research

摘　　要：目的分析内镜黏膜下剥离术(ESD)与内镜分片黏膜切除术(EPMR)治疗直径>15 mm食管黏膜病变的方法和疗效。方法回顾性分析2012年1月至2017年10月收治的200例食管黏膜病变(直径>15 mm)患者的临床资料,其中100例接受ESD治疗的患者纳入ESD组,100例接受EPMR治疗的患者纳入EPMR组,比较两组临床治疗效果及并发症发生情况,随访1年,记录两组复发情况。结果 ESD组中,水平切缘阳性有5例(浸润黏膜下层深度均超过200μm),病灶整块切除率为100%,完整切除率为96%,治愈性切除率为91%;EPMR组中,水平切缘阳性有3例,患者无病灶整块切除。两组水平切缘情况比较无统计学差异(P>0.05)。与EPMR组比较,ESD组的手术时间较长,病灶较大(P<0.01)。两组术中穿孔率、术后出血发生率、术后1年食管狭窄率比较差异无统计学意义(P>0.05)。在1年随访期内,ESD组中有4.21%出现局部复发,EPMR组中有11.34%出现局部复发,两组复发率比较无统计学差异(χ^2=3.384,P=0.066)。结论内镜黏膜下剥离术治疗直径>15 mm食管黏膜病变的效果优于内镜分片黏膜切除术。Objective To compare the effects of endoscopic submucosal dissection(ESD) and endoscopic piecemeal mucosal resection(EPMR) in the treatment of esophageal mucosal lesions larger than 15 mm in diameter.Methods A retrospective analysis was performed on the clinical data of 200 patients with esophageal mucosal lesions(more than 15 mm in diameter) admitted to hospital from January 2012 to October 2017.The patients were divided into ESD group(receiving ESD operation) and EPMR group(receiving EPMR operation,n=100,each).The clinical outcomes,the complications and the recurrence during one-year follow-up were observed and compared between two groups.Results In ESD group,there were 5 cases with positive horizontal margin(invasive submucosal depths exceeding 200 μm).The total resection rate was 100%,the complete resection rate was 96%,and the curative resection rate was 91%.In EPMR group,there were 3 cases with positive horizontal margin.No entire excision of lesions was conducted.There was no significant difference in comparison of horizontal margin between two groups(P>0.05).Compared with EPMR group,the operation time was the longer,and the lesions was the larger in ESD group(all P<0.01).There were no significant differences in the rates of perforation and postoperative hemorrhage,the incidence of esophageal stricture one year after operation(all P<0.05).During one-year follow-up period,the local recurrence rates were 4.21% in ESD group and 11.34% in EPMR group(χ^2=3.384,P=0.066).Conclusion Endoscopic submucosal dissection is superior to endoscopic piecemeal mucosal resection in the treatment of esophageal mucosal lesions more than 15 mm in diameter.

关 键 词：食管黏膜病变 内镜黏膜下剥离术 内镜分片黏膜切除术 食管狭窄 复发 

分 类 号：R735.1[医药卫生—肿瘤]