内镜黏膜下剥离术治疗消化系统早癌及癌前病变的临床疗效

Clinical Effect of Endoscopic Submucosal Dissection on Trealmento of Gastrointestinal Carcinoma in Early Stage and Precanceious Lesions

目的:探讨内镜黏膜下剥离术(ESD)对消化道早癌及癌前病变的治疗效果。方法:选择2013年8月至2014年8月在我院接受治疗的消化道肿瘤患者79例作为研究对象,根据手术方法不同将所选患者分为ESD组(49例)和对照组(30例)。ESD组患者采用内镜黏膜下剥离术治疗,对照组采用传统手术治疗。观察并比较两组患者的手术时间、治愈性切除率、整块完整切除率、术后并发症的发生率及复发、转移情况。结果:ESD组患者的手术时间少于对照组,差异具有统计学意义(P<0.05);两组患者手术治愈性切除率均为100%,差异无统计学意义(P>0.05);ESD组手术整块完整切除率(63.27%)低于对照组(86.67%),差异具有统计学意义(P<0.05)。ESD组患者术后并发症的发生率(4.08%)显著低于对照组(13.3%),差异具有统计学意义(P<0.05)。两组患者术后一年内均未出现原发病灶转移及复发。结论:ESD治疗消化道早癌及癌前病变的临床疗效较好,与传统手术相比,ESD手术并发症较少、且安全性较高,更加适宜临床推广及应用。

Objective： To investigate the clinical effect of endoscopic submucosal dissection （ESD） on the treatment of gastrointestinal carcinoma in early stage and precancerous lesions. Methods： 79 patients with gastrointestinal carcinoma who were treated in our hospital from August 2013 to August 2014 were selected as the research subjects. According to the different operation methods, the selected patients were divided into the ESD group （49 cases） and the control group （30 cases）. The patients in ESD group were treated with endoscopic submucosal dissection, and the patients in the control group were treated with conventional surgery. Then the operation time, curative resection rate, the whole complete resection rate, postoperative complication and recurrence and metastasis in the two groups were observed and compared. Results： The operation time in the ESD group was less than that of the control group, and the difference was statistically significant （P〈0.05）; The curative resection rate in the two groups were 100%, and there was no statistically significant difference （P〉0.05）; The whole complete resection rate in the ESD group was 63.27% which was lower than 86.67% of the control group, and the difference was statistically significant （P〈0.05）. The incidence of postoperative complications in the ESD group was 4.08% which was lower than 13.3% in the control group, and the difference was statistically significant （P〈0.05）. There was no metastasis and recurrence of primary lesions in the two groups after the operation for one year. Conclusion： The clinical effect of ESD on the treatment of gastrointestinal carcinoma and precancerous lesion is better. Compared with the conventional operation, ESD has less complications and higher safety, which is more suitable for clinical application.