摘要
目的评价内镜黏膜下剥离术（ESD）治疗胃食管交界部早期癌（高级别上皮内瘤变和黏膜内癌）的价值。方法回顾性分析2006年11月至2011年3月复旦大学附属中山医院行ESD治疗的57例胃食管交界部早期癌患者的临床资料，观察患者手术时间、出血量、肿瘤切除情况及围手术期并发症，分析手术前后病理检查结果。结果57例患者顺利完成了ESD，中位手术时间为55min（25—95min），中位出血量为74ml（20—300ml）。其中39例患者整块切除肿瘤、18例患者分块切除肿瘤。术中并发症发生率为25％（14／57），其中穿孔5例、出血9例。术后并发症发生率为16％（9／57），其中迟发性出血6例、胃食管交界部狭窄3例。术前活组织病理检查提示为高级别上皮内瘤变的39例患者中，有3例术后病理检查确诊为黏膜内癌；术前活组织病理检查提示为黏膜内癌的18例患者中，有4例术后病理检查确诊为腺癌。本组患者随访9～27个月，创面愈合良好，均无肿瘤复发、转移。结论ESD治疗胃食管交界部早期癌安全、可靠，具有较好的疗效。
Objective To assess the value of endoscopic submucosal dissection （ESD） for the treatment of early tumors located at the esophagogastric junction. Methods The clinical data of 57 patients with early tumors located at the esophagogastric junction who received ESD at the Zhongshan Hospital from November 2006 to March 2011 were retrospectively analyzed. The operation time, blood loss, resection of tumor and perioperative complications were observed. The pre- and postoperative pathological findings were analyzed. Results ESD was successfully completed on the 57 patients. The median operation time was 55 minutes （range, 25-95 minutes） , and the median volume of blood loss was 74 ml （range, 20-300 ml）. En-bloc and piecemeal resections were carried out on 39 and 18 patients, respectively. The operative complication rate was 25% （ 14/57 ）, including 5 patients complicated with perforation and 9 with bleeding. The postoperative complication rate was 16% （9/57）, including 6 patients complicated with delayed hemorrhage and 3 with stricture of the esophagogastric junction. Of the 39 patients who were diagnosed as with high-level intraepithelial neoplasia preoperatively, 3 were confirmed as with intramucosal carcinoma; of the 18 patients who were diagnosed as with intramucosal carcinoma preoperatively, 4 were confirmed as with adenocarcinoma. All patients were followed up for 9-27 months, no recurrence or metastasis was found. Conclusion ESD is effective and safe for the treatment of early tumors located at the esophagogastric junction.
出处
《中华消化外科杂志》
CAS
CSCD
2011年第3期185-187,共3页
Chinese Journal of Digestive Surgery
基金
上海市科委重大课题（09DZ1950102）
上海市科委生物医药处面上项目（09411967100）
关键词
胃食管交界部肿瘤
上皮内瘤变
黏膜内癌
内镜黏膜下剥离术
Esophagogastric neoplasms
Intraepithelial neoplasia
Intramucosal carcinoma
Endoscopic submucosal dissection
