经内镜黏膜下剥离术与黏切除术治疗胃部早期病变的临床疗效观察

Comparison of endoscopic submucosal dissection with endoscopic mucosal resection in the treatment of early gastric cancer

目的观察经内镜黏膜下剥离术(ESD)与黏膜切除术(EMR)治疗胃早期病变的临床疗效。方法对内镜及病理确诊为早期胃癌及高级别上皮内瘤变的患者进行EMR(39例)和ESD(45例)治疗,分别对其整块切除、完全和不完全切除、手术时间、术中和术后出血、穿孔、复发率等进行统计,利用卡方检验对两者的疗效进行统计分析。结果 (1)在未伴发溃疡的情况下,不论病灶大小,ESD组整块切除率和完全切除率均明显高于EMR组(P<0.01),在伴发溃疡的情况下,不论病灶大小,组间差异无统计学意义(P>0.05);(2)不论病灶大小及是否伴发溃疡,ESD组的平均手术时间均远长于EMR组(P<0.05),且ESD组的术中出血率明显高于EMR组(P<0.05),但术后出血率组间差异无统计学意义(P>0.05);只有在伴发溃疡的情况下,ESD发生穿孔的风险性才高于EMR组(P<0.05);(3)ESD组术后患者均无局部复发,而EMR组术后患者分次切除病变局部复发率明显高于整块切除(P<0.05)。结论 ESD在治疗胃早期病变中整块切除和组织完全切除率明显高于EMR,且术后几乎无复发。但ESD操作时间较长,术中存在较高的穿孔、出血风险性。

Objective To investigate the effect of endoscopic submucosal dissection （ESD） and endoscopic mucosal resection （EMR） in the treatment of early gastric cancer. Methods EMR （39 patients, EMR group） or ESD （45 patients, ESD group） was performed on patients who were diagnosed as early gastric cancer （EGC） with cervical intraepithelial neoplasia. The en bloc resection rate, incomplete and complete resection rate, operation duration, intraoperative and post- operative bleeding, perforation, and recurrence rate were studied and analyzed by the Z2 test. Results （1） In patients without ulceration, the en bloc resection rate and complete resection rate were significantly higher in ESD group than EMR group （P〈0.01）, regardless of tumor size, which showed no statistically significant difference between the two groups for pa- tients complicated with ulceration （P〉0.05）. （2） In patients without ulceration, the average operation duration was signifi- cantly longer in ESD group （P〈0.05） regardless of ~rnor size, and the incidence of intraoperative bleeding was significantly higher （P〈0.05）, but the incidence of postoperative bleeding showed no statistically significant difference between the two groups （P〉0.05）. In patients with ulceration, the incidence of perforation was significantly higher in ESD group than EMR group （P〈0.05）. （3） In EMR group, local recurrences by en bloc resection was significantly higher than that by incomplete resection （P〈0.05）. No patient experienced recurrence in ESD group. Conclusion ESD can increase the en bloc and histologically complete resection rate and reduce the local recurrence rate, but resulting in increased operation duration, higher risk of perforation and bleeding during and after the treatment, compared with EMR.