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内镜黏膜下剥离术对残胃或胃管中的早期胃癌的临床疗效

发布日期:2014-1-29 12:40:43 文章来源:ENDOSCOPY 作者次数:1126
    内镜黏膜下剥离术对残胃或胃管中的早期胃癌的临床疗效

    N. Nishide, H. Ono, N. Kakushima, K. Takizawa, M. Tanaka, H. Matsubayashi, Y. Yamaguchi

    日本静冈县静冈癌症中心内镜科

    背景与研究目的:关于残胃或胃管中的早期胃癌(EGC)的最佳治疗资料较少。本研究目的是评估内镜黏膜下剥离术(ESD)对残胃或胃管中的早期胃癌(EGC)治疗的可行性和临床疗效。

    患者与方法20029月至200912月,我们对59残胃或胃管中的早期胃癌患者进行了内镜黏膜下剥离术,共62处病变,其中,48处残胃病变,14处胃管病变。同时,我们对临床病理资料进行了回顾性检索,以评估整块切除率、并发症和疗效。最后,根据内镜下切除适应症对治疗结果进行了评估,并将这些结果与同期研究对全胃实施内镜黏膜下剥离术的结果进行了比较。

    结果:标准和扩展适应症内的病变整块切除率分别为100%93%5例患者发生术后出血,所占比例为8%。其穿孔发生率显著高于对全胃行内镜黏膜下切除术后的穿孔发生率,二者发生率分别为18%11 /62)和5%69 /1479)。在发生穿孔的病例中,8处病变出现吻合口或残端线,而且5处病变出现溃疡性变化。3年的总生存率为85%,由于其它原因所致8例患者死亡,而没有因胃癌发生死亡的患者。

    结论:采用内镜黏膜下剥离术治疗残胃或胃管中的早期胃癌,其整块切除率较高;然而,由于该手术会导致穿孔并发症发生率较高,所以它在技术上还有很大的挑战性。

     


     

    Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube

    N. Nishide, H. Ono, N. Kakushima, K. Takizawa, M. Tanaka, H. Matsubayashi, Y. Yamaguchi

    Division of Endoscopy, ShizuokaCancerCenter,Shizuoka,Japan

    Background and study aims: Little information exists regarding the optimal treatment of early gastric cancer (EGC) in a remnant stomach or gastric tube. The aim of this study was to assess the feasibility and clinical outcomes of endoscopic submucosal dissection (ESD) for EGC in a remnant stomach and gastric tube.

    Patients and methods: Between September 2002 and December 2009, ESD was performed in 62 lesions in 59 patients with EGC in a remnant stomach (48 lesions) or gastric tube (14 lesions). Clinicopathological data were retrieved retrospectively to assess the en bloc resection rate, complications, and outcomes. Treatment results were assessed according to the indications for endoscopic resection, and were compared with those of ESD performed in a whole stomach during the same study period.

    Results: The en bloc resection rates for lesions within the standard and expanded indication were 100 % and 93 %, respectively. Postoperative bleeding occurred in five patients (8 %). The perforation rate was significantly higher (18 %, 11 /62) than that of ESD in a whole stomach (5 %, 69 /1479). Among the perforation cases, eight lesions involved the anastomotic site or stump line, and ulcerative changes were observed in five lesions. The 3-year overall survival rate was 85 %, with eight deaths due to other causes and no deaths from gastric cancer.

    Conclusion: A high en bloc resection rate was achieved by ESD for EGC in a remnant stomach or gastric tube; however, this procedure is still technically demanding due to the high complication rate of perforation.

     

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