消化内镜技术用于消化道早癌诊断治疗价值研究

How nova endoscopic procedures altered the diagnostic and therapeutic modality of early gastrointestinal cancer

目的探讨内镜新技术用于消化道早癌诊治临床价值。方法应用解放军总医院内镜中心数据库系统,对2002—2011年消化内镜检查数据进行统计分析,探讨消化道早癌的诊断及治疗最佳方式。结果近十年来,随着内镜新技术的不断应用,解放军总医院消化内镜中心对消化道早癌的检出率逐年上升,由最初2002年的0.90%上升至2011年的2.02%。自2006年至2011年,共871例消化道早癌接受内镜治疗,其中分别有207例早期食管癌、429例早期胃癌及235例早期大肠癌,内镜根治切除的比例分别为37.8%(207/547),36.7%(429/1167)和40.2%(235/584),其中239例使用内镜下黏膜切除术(EMR)或内镜下分次切除术(EMPR)术,542例使用内镜下黏膜剥离术(ESD)术治疗,术前使用内镜新技术的诊断准确率为97.5%(849/871)。使用内镜治疗的病变的平均尺寸为:早期食管癌2.59 cm×1.91 cm,早期胃癌2.98 cm×2.18 cm,早期大肠癌3.37 cm×2.21 cm。结论消化内镜新诊治技术的出现不但明显提高了消化道早癌的检出率、同时深刻改变了消化道早癌的治疗模式。

Objective To make an analysis on how new endoscopic techniques and procedures influence the detection rate and therapeutic modality choice of early gastrointestinal cancer. Methods We entered the data base of Chinese PLA＇s General Hospital＇s endoscopy center, searching all the data for the last decade （2002-2011）. Data were later analyzed and compared. Results During the last decade, the detection rate of early gastrointestinal cancer in Chinese PLA＇s General Hospital had been increasing, from 0. 90% （2002） to 2. 02% （2011 ）. Since 2006, when new endoscopic therapeutic means were first introduced to our center,a total of 871 patients were treated endoscopically,329 of which were through EMR or EPMR means and 542 were using ESD. The rate of endoscopic therapy were 37.8% （207/547）for early esophageal cancer, 36.7% （429/1167 ）for early gastric cancer and 40.2% （235/584）for early colon cancer. The diagnostic accuracy of new endoscopic means was 97.5% （849/871）. And the average size of endoscopically removed lesions were as follow：early e- sophageal cancer 2. 59 cmx 1.91 cm,early gastric cancer：2. 98 cm ×2. 18 cm and early colon cancer：3.37 cm ×2. 21 cm. Conclusion The emergence and application of new endoscopic techniques in the past decade, had improved the detection rate of early gastrointestinal cancer and profoundly changed its therapeutic modality.