胃和食道早癌及癌前病变的内镜下黏膜切除术及黏膜下剥离术的临床疗效

Clinical effects of endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric and esophageal cancer and precancerous lesions

目的:了解内镜下黏膜切除术(endoscopic mucosal resection,EMR)及内镜下黏膜下剥离术(endoscopic submucosal dissection,ESD)对胃和食道早癌及癌前病变可行性、安全性及疗效.方法:2011-03/2014-06行胃镜及病理活检诊断为胃和食道早癌及癌前病变或术后病理明确行内镜下治疗患者共93例,分为ESD治疗组(n=61)和EMR治疗组(n=32).通过手术时间、病变的大小、整片切除率及手术并发症和术后复发情况,对两者进行比较.结果:两组的年龄、病变大小无统计学差异ESD组时间明显大于EMR组.ESD组的整片切除率大于EMR组.ESD组有5例术中出血,EMR组有1例术中出血,均无迟发性出血.ESD组有1例穿孔,EMR组无穿孔.两组出血及穿孔均无明显差异(P>0.05).术后随访3-42 mo,ESD组0例复发(0.0%),EMR组4例复发(12.5%),两组均无死亡病例.结论:ESD有更高的整片切除率及长期随访中有更低的复发率.两组出血及穿孔并发症无显著差异,且均在可控制范围内.在条件容许条件下,优先选择ESD.

AIM： To evaluate the feasibility, safety and ef- ficacy of endoscopic mucosal resection （EMR） vs endoscopic submucosal dissection （ESD） for early gastric and esophageal cancer and precancerous lesions. METHODS： A retrospective analysis was per- formed of 93 patients with early gastric/esopha- geal cancer or precancerous lesions who were endoscopically and pathologically diagnosed and managed by ESD or EMR at our hospital from March 2011 to June 2014. The patients were divided into either an ESD group （61 patients） or an EMR group （32 patients）. The operative time,size of the lesion, en bloc resection rate, surgi- cal complications and postoperative recurrence were compared for the two groups to evaluate their feasibility, safety and efficacy. RESULTS： There was no significant difference in age or lesion size between the two groups. The en bloc rate was significantly higher in the ESD group than in the EMR resection （91.8% vs 56.3%, P 〈 0.05）. There are five cases of bleeding in the ESD group and one in the EMR group, and no delayed bleeding occurred in either group. There was only one case of perforation, which occurred in the ESD group. During the 3-42-month postoperative follow-up, there was no recurrence in the ESD group, but four cases of recurrence occurred in the EMR group. CONCLUSION： Compared with EMR for early gastric and esophageal cancer and precancer- ous lesions, ESD shows considerable advantages regarding en bloc resection rate and local recur- rence, although there is no significant difference in bleeding or perforation.