设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

内镜黏膜下剥离术或经肛门内镜显微手术治疗直肠非息肉状高度不典型增生和侵至粘膜下层的直肠癌

发布日期:2014-1-29 12:40:59 文章来源:GIE 作者次数:1786
     

    *                               Korea韩国首尔成均馆大学医学院三星医疗中心胃肠科

    *                               韩国首尔成均馆大学医学院三星医疗中心外科

    摘要

    背景与研究目的已证明经肛门内镜显微手术(TEM)对早期直肠癌非常有效, 同时有人已经采用内镜黏膜下剥离术(ESD)非侵入性治疗结直肠瘤。本研究是为了比较ESDTEM浅表部位早期直肠癌的治疗效果。

    患者与方法:我们对63直肠非息肉状高度不典型增生侵至粘膜下层的直肠癌癌患者进行了回顾性分析,这些患者要么接受ESD治疗,要么接受TEM治疗,最后,比较两治疗组间的临床效果和安全性。

    结果:30例患者接受ESD33例患者接受TEM。采用ESDTEM的整块切除率分别为96.7 % 100 % R0切除率分别为96.7%和97.0%(P = 1.000)。两组均没有局部复发或远端转移病例。ESD组与TEM组分别有11例和33例患者需抗生素治疗,二者比例分别为36.7 %100 %P < 0.001)。尽管ESD组的总手术时间和住院天数比TEM组短,即二者平均总手术时间(标准偏差[SD])分别为84.051.2)与116.458.5)分钟(P = 0.0023),平均住院天数分别为3.61.2)与6.63.5)天(P < 0.001)。两组间并发症无显著差异。

    结论:ESD TEM均可有效治疗非息肉性直肠高度不典型增生和黏膜下侵入癌,而且从肿瘤学角度来说二者都是是安全的。但ESD还具有额外优势,即侵入程度最小,且不需麻醉。因此,我们推荐浅表部位早期直肠癌患者应选择ESD进行治疗。


     

    Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer


    S. U. Park1, *, Y. W. Min1, *, J. U. Shin1, J. H. Choi1, Y-H. Kim1, J. J. Kim1, Y. B. Cho2, H. C. Kim2, S. H. Yun2, W. Y. Lee2, H-K. Chun2, D. K. Chang1

     

    Background and study aims: Transanal endoscopic microsurgery (TEM) has been shown to be highly effective for early rectal cancer, and endoscopic submucosal dissection (ESD) has been introduced to treat noninvasive colorectal neoplasia. The aim of this study was to compare the outcomes of ESD and TEM for superficial early rectal cancer.

    Patients and methods: We retrospectively analyzed 63 patients with nonpolypoid rectal high grade dysplasia or submucosa-invading cancer who were treated with ESD or TEM, and compared clinical outcomes and safety between the treatment groups.

    Results: 30 patients underwent ESD and 33 underwent TEM. For ESD compared with TEM, en bloc resection rates were 96.7 % vs. 100 % (P = 0.476) and R0 resection rates were 96.7 % vs. 97.0 % (P = 1.000). There were no cases of local recurrence or distant metastasis in either group. Antibiotics were required in 11 patients (36.7 %) in the ESD group and 33 (100 %) in the TEM group (P < 0.001). There was no difference in net procedure time although ESD was associated with shorter total procedure time and hospital stay than TEM, with mean (standard deviation [SD]) 84.0 (51.2) vs. 116.4 (58.5) min (P = 0.0023), and 3.6 (1.2) vs. 6.6 (3.5) days (P < 0.001), respectively. There were no significant differences in complications between the two groups.

    Conclusions: Both ESD and TEM are effective and oncologically safe for treating nonpolypoid rectal high grade dysplasia and submucosa-invading cancers. ESD has the additional advantages of minimal invasiveness and avoidance of anesthesia. Therefore, ESD could be recommended as a treatment option for superficial early rectal cancers.

     

     

    (作者:)
相关评论
用户名: 登录