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内镜黏膜下剥离术和内镜黏膜切除术治疗胃食管连接部癌前病变及早癌的疗效比较

(2014-10-22 12:23:22)

    【摘要】

    目的 将内镜黏膜下剥离术(ESD)和内镜黏膜切除术(EMR)进行比较,评价ESD治疗胃食管连接部(GEJ)癌前病变及早癌的有效性及安全性。

    方法 分析28例经ESD治疗和51例经EMR治疗的GEJ癌前病变及早癌患者的临床资料,比较两种方法病灶整块切除率、组织学治愈性切除率、手术时间、并发症、复发率等。

    结果 ESD整块切除率为92.9%26/28),治愈切除率为78.6%22/28)均优于EMR组分别为45.1%23/51)、43.1%22/51)。两者差异有统计学意义(P均<0.05)。局部原位复发率ESD组为3.6%1/28),明显低于EMR组的19.6%10/51)(P0.05)。术后延迟出血、穿孔、狭窄等严重并发症的发生ESD组与EMR组之间差异无统计学意义。平均手术时间ESD为(64.3±27.1min明显长于EMR(27.6±14.1)minP0.05)。

    结论 ESDEMR相比整块切除率及组织学治愈性切除率高,局部复发率低,是治疗GEJ癌前病变及早癌的安全有效的方法并优于EMR

    【关键词】胃食管连接部;肿瘤;内镜黏膜下剥离术;内镜黏膜切除术


     

    [Abstract] Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for precancerous lesions and early cancer at gastroesophageal junction (GEJ) by comparing endoscopic mucosal resection (EMR) with ESD. Methods  Data of patients with GEJ precancerous lesions or early cancer, who received EMR (n=51) or ESD (n=28) were reviewed to compared the en bloc resection rate, R0 resection rate, operation time, complication and recurrence rate between 2 methods. Results En bloc resection and R0 resection rates of ESD group (92.9%, 78.6% respectively) were significantly higher  than those of EMR group (45.1%, 43.1% respectively). Local recurrence rate in ESD group (3.6%, 1/28) was significantly lower than that of EMR group (19.6%). Complications including perforation, delayed  hemorrhage, stricture were not significantly different between EMR and ESD groups. Mean operation time of ESD group (64.3±27.1min) was significantly longer than that of EMR group (27.6±14.1min) (P<0.05). Conclusion ESD, with a higher cure rate and en bloc rate and a lower local recurrence rate, is superior to EMR for precancerous lesions and early cancer at GEJ.

    [Key words] Gastroesophageal junctionNeoplasmsEndoscopic mucosal resectionEndoscopic submucosal dissection

     

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个人资料
    邹晓平 单位:南京大学医学院附属鼓楼医院
    所属科室:消化科
    出生:1974-03-10
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