摘要
目的探讨内镜黏膜下剥离术（ESD）治疗老年早期胃癌的疗效和安全性。方法按照入选标准对于年龄≥60岁的早期胃癌患者进行ESD治疗，观察疗效及术中并发症情况，术后予禁食、抑酸补液治疗，并定期随访评价病灶有无残留和复发。结果共有55例患者入组，男性44例，女性11例。完整大块切除率100％，组织学完全切除率为92．7％（51／55）。术中少量出血率16．4％，贲门胃底部发生率（5／13，35．5％）高于其他部位（P=0．02）。穿孔发生率（1／55，1．8％），位于胃角，予金属夹夹闭。术后迟发出血3例（3／55，5．5％），其中2例病变位于胃窦，24h内发生，均经急诊胃镜下治疗成功止血，1例胃角，术后1周发生，1月反复，内科保守治疗有效。总随访时间2月-38月，中位随访时间7月，共随访51例，失访率7．2％，无病灶残留，1例患者于ESD治疗后8月随访时发现复发，转外科行手术治疗。结论ESD是治疗老年早期胃癌的一种有效且安拿的治疗方法。
Objective To evaluate the effectiveness and safety of endoscopic submucosal dissection for early gastric cancer in the elderly. Methods The patients with early gastric cancer older than 60 years were enrolled according to the selected criteria from August 2006 to October 2009. We performed ESD procedures on them and assessed the curability and the complications. Fasting and acid suppression were administered postoperatively, regular follow-up endoscopy was taken to evaluate the residual or local recurrence in the lesions. Results A total of 55 elderly patients were studied, and the male： female ratio was 4：1 （44：11）. The rates of the complete chunks and histological resection were 100 % and 92.7 % （ 51/55 ）, respectively. Minor bleeding during the ESD procedure occurred in 16.4% （9/55）, which happened more often in the fundus and cardia of stomach （5/13, 35,5%）. One small perforation was encountered in stomach corner and clamped by metalclips. The delayed bleeding rate was 5.5 % . Two antrum EGC occurred during 24 hours post-operation but were both managed successfully by endoscopic haemostasis. The other bleeding case occurred in gastric angle one week after ESD and recurred three weeks later, and the patient was efficiently treated conservatively. 51 patients were visited in the meso followup period about 7 months. Though no residue was found, there was one recurrent tumor 8 months later and underwent surgery. Conclusion ESD is a safe and effective treatment for EGC in the elderly.
出处
《老年医学与保健》
CAS
2010年第2期79-81,85,共4页
Geriatrics & Health Care
关键词
胃肿瘤
老年
内镜黏膜下剥离术
治疗
Stomach neoplasms
Elderly
Endoscopic submucosal dissection
Therapy
