内镜黏膜下剥离术和黏膜切除术治疗早期胃癌的临床对比分析

The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resectionfor early gastric cancer

目的 探讨内镜黏膜下剥离术（ESD）及内镜下黏膜切除术（EMR）治疗早期胃癌的临床疗效。方法 对该院2008年1月~2013年1月行内镜黏膜下剥离术及内镜下黏膜切除术后病理证实为癌前病变及早期胃癌的67例患者进行回顾性分析。将两组病灶整块切除率、组织学治愈性切除率、手术时间、并发症发生率、复发率等指标进行比较。结果 ESD组病灶整块切除率为93.5%（29/31）,治愈性切除率为77.4%（24/31）,均高于EMR组的50.0%（18/36）及41.6%（15/36）,差异有显著性（〈0.05）。ESD组局部复发率为3.2%（1/31）,低于EMR组[19.4%（7/36）],差异有显著性（〈0.05）。平均手术时间ESD组为（59.3±16.8）min,长于EMR组（[31.7±17.8）min（]〈0.05）。术中穿孔率ESD组高于EMR组,发生率分别为3.2%（1/31）和0.0%（0/36）,但差异无显著性。术中出血发生率两者差异无显著性,发生率分别为9.6%（3/31）及11.1%（4/36）。结论 与EMR相比,ESD病灶整块切除率及组织学治愈性切除率高,局部复发率低,是治疗早期胃癌的安全有效方法。

[ Objective ] To evaluate whether or not endoscopic mucosal resection and endoscopic submucosal dissection are efficient and safe for early gastric cancer. [Methods] The clinical data of patients whose pathological results were early gastric cancer between January 2008 and January 2013 were collected. Sixty-seven patients were included.The two groups from the en bloc resection rate, R0 resection rate, operation time, complication and recurrence rate were compared. [Results] En bloc resection and R0 resection rates of ESD group （93.5%, 77.4% respectively） were significantly higher than those of EMR group （50%, 41.6% respectively）. Local recurrence rate in ESD group （3.2%, 1/31） was significantly lower than that of EMR group （19.4%）. Mean operation time of ESD group （59.3±16.8） min was significantly longer than that of EMR group （31.7±17.8） min （P〈0.05）. Complications of perforation in ESD group was higher than that of EMR group, but there was not different between ESD group and EMR group on haemorrhage. [ Conclusion ] ESD, with higher cure rate and en bloc rate and a lower local recurrence rate, is superior to EMR for early gastric cancer.