摘要
目的分析内镜下黏膜剥离术(ESD)治疗胃黏膜高级别上皮内瘤变(HGIN)及早期胃癌(EGC)的远期疗效及影响囚素。方法回顾性研究解放军总医院消化内镜中心2006年11月至2010年8月共治疗的80例胃黏膜HGIN及EGC患者的资料,分析ESD治疗HGIN及EGC的疗效及其病变形态、浸润深度、病理类型对切除效果的影响。评价指标:完整切除率、组织学治愈率、生存率、并发症、复发率。结果内镜下ESD完整切除75例,切除率93.8%,组织学治愈79例,治愈率98.8%,其中,HGIN、黏膜内癌、黏膜肌层癌、黏膜下癌ESD完整切除率分别是100%(31/31)、92.3%(24/26)、92.3%(12/13)、80.0%(8/10);组织学治愈率分别是100%、(31/31)、100%(26/26)、100%(13/13)、90.0%(9/10):HGIN、黏膜内癌、黏膜肌层癌及黏膜下癌不同病理分型间完整切除率无差别,P>0.05;HGIN、黏膜内癌、黏膜肌层癌及黏膜下癌不同病理分型间组织学治愈率有差别,P<0.05。术中明显出血发生率为0;穿孔发生率0,术后迟发出血发生率2.5%,52例ESD患者术后随访,复发残留率1.9%(1/52),生存率100%(52/52)。结论 ESD组织学治愈率、复发率与病变病理类型、浸润深度有关。内镜下ESD治疗胃黏膜HGIN和EGC并发症少、生存率高。
Objective To compare the effect of endoscopy submucosal dissection （ESD） and surgical resection for high-grade gastric intraepithelial neoplasia （HGIN） and early gastric cancer （EGC） , Methods Data of 80 patients with HGIN and EGC, who received ESD from November 2006 to Augest 2010 in Chinese PLA General Hospital,were reviewed. And effects of ESD and factors affetcing success rate were anlalysed. The primary indicators were the rate of complete resection, histological healing rate and survival rate.The second indicators were complications , recurrence rate and life quality after operation. Results The complete resection rate and histological healing rate by ESD were 93.8% and 98.8%, in which 100% and 100% for HGIN, 92.3% and 100% for intramucosal carcinoma, 92.3% and 100% for muscularis mucosal carcinoma , 80% and 90% for submucosal cancer, respectively. As to the former four different pathological types, the rates of complete resection made no statistical differences （P〉0.05） , but histological healing rates differed statistically （P〈0.05） .The rates of obvious bleeding during the operation, perforation,delayed bleeding after operation were 0%, 0% and 2.5%, respectively.The follow-up of 52 patients after ESD showed that the rate of recurrence and residue was 1.9%, and survival rate was 100%. Conclusions 1.The rates of histological healing and recurrence after ESD are associated with the pathological types and the invasive depth （P〈0.05） ;2. The patients undergoing ESD have minor wound, quick recovery and high life quality after operation.
出处
《中华胃肠内镜电子杂志》
2014年第1期11-16,共6页
Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)
