黏膜切除术治疗早期胃癌

Endoscopic Mucosal Resection of Early Gastric Cancer

目的:探讨双钳道内镜黏膜切除术(EMR)在早期胃癌治疗中的应用价值。方法:对36例早期胃癌,用双钳道内镜进行黏膜切除术,总经分析其术后疗效,并发症。结果:36例病例中,10例(28%)分片切除,26例(72%)整片切除,30例(83%)成功行内镜黏膜完全切除术。病灶直径均<2Cm。术后有12例出现上腹部不适。出血3例,1例用钛夹、2例用APC止血。狭窄1例,采用球囊扩张。没有死亡病例。随访12月,在治愈组中,无复发及远处转移。结论:双钳道内镜EMR治疗早期胃癌安全实用。

Objective： Endoscopic mucosal resection（EMR） has been developed as a treatment for early gastric cancer （EGC） by using a double-channel endoscope. The aim of the present work was to determine the safety and efficacy of the endoscopic treatments for EGC. Methods：36 patients were enrolled in the study. 36 EMR procedures were performed with the strip biopsy technique using a double-channel endoscope. En bloc resection refered to resection in one piece, while piecemeal rcfered to resections in which the lesion was removed in multiple fragments. We defined as curative treatment lateral and vertical margins of the resected specimens free of cancer and repeated endoscopic finding of no recurrent disease. Results：Out of 36 EMR procedures, I0 were piecemeal resections（28%）, while 26 were en bloc （72%）. Histological assessment of curability in the EMR group was achieved in 83% of the cases. All the lesion size was less than 20 mm. After operation, 12 patients had little stomachack. We had 30 cases of bleeding （8%）, one by eodoclip and two with APC. One patient had stenosis（3%） was submitted to one session of pneumatic dilation. There was no procedure-relatod mortality in our series. Mean follow＇up period was 12 months. There was no local recurrence or distant metastasis in the curative group patients. Conclusions：These results seemed to confirm the safety and the clinical efficacy of the EMR procedure.