早期胃癌行内镜黏膜下剥离术指征及评价

Indication and evaluation of endoscopic submucosa dissection in the treatment of early gastric cancer

内镜黏膜下剥离术(ESD)是一种内镜下整块切除病变黏膜的治疗方法,已经成为早期胃癌的治疗选择之一。目前ESD治疗早期胃癌较为积极的指征为:(1)分化型黏膜内癌如果表面未形成溃疡,则病变大小不受限制;(2)分化型黏膜内癌如果表面已经形成溃疡,则病变直径≤30mm;(3)分化型sm1癌,病变直径≤30mm;(4)未分化型黏膜内癌,表面未形成溃疡,且病变直径≤20mm。尽管长期随访的资料较少,但目前看来,如果合理地把握ESD治疗指征,早期胃癌的治愈率与手术相当,但可减少并发症,提高病人生活质量,具有安全、可行、有效的特点。

Endoscopic submucosal dissection （ESD） is a new teehnique developed to Obtain one-pieee resection even for large and ulcerative lesions, permitting removal of early gastric cancer （EGC）en bloc. The extended criterias of the ESD operation on EGC include that （1） differentiated mucosal ! cancers without ulceration irrespective of tumor size; （2） differentiated mucosal cancers irrespective of ulcer less than 30mm; （3）differentiated sml carcinoma, lesion diameter less than 30mm; （4）undifferentiated mucosal cancers without ulceration less than 20mm. If ESD is performed for patients with EGC that fulfilled the suitable criteria, the prognosis is similar to the traditional open surge~＇y. Complications may be reduced and the quality of patients＇ life can be improved significantly. ESD is an effective and safe therapy in tile management of EGC.