内镜下氩离子凝固术治疗老年患者胃低级别瘤变

Endoscopic argon plasma coagulation treated low-grade gastric intraepithelial neoplasia in 62 elderly patients

目的探讨内镜下氩离子凝固术（APC）治疗老年人低级别瘤变的有效性及安全性。方法回顾性研究分析2013年10月～2014年4月在解放军总医院南楼消化内镜诊疗科行胃镜检查，病理证实为胃低级别瘤变的老年患者62例临床资料。随机选择两种治疗方法：先黏膜下注射生理盐水，再进行APC治疗和直接APC治疗。术后随诊不良反应，治疗后6周及6个月后进行内镜及病理组织学复查。结果6周后51例患者返院复查共62个病灶，57个无残留，治疗有效率91．9％。6个月后43例患者返院复诊45个病灶，42个无残留，治疗有效率为93_3％。中度不典型增生病灶复发率较高（6／14）。两种治疗方法的有效率差异无统计学意义（P〉0．05）。所有患者无1例出现出血、穿孔等并发症，术后不良反应轻微，均可耐受。结论内镜下氩离子凝固术治疗老年患者胃低级别瘤变安全有效，治疗后要拟定个体化的内镜随诊方案。

Objective To evaluate the efficacy and safety of argon plasma coagulation （APC） for gastric low-grade intraepithelial neoplasia （LGIN） in elderly patients. Methods We retrospectively selected elderly patients with gastric low-grade intraepithelial neoplasia in our hospital and performed APC under endoscopic examination, and we randomly sorted the patients into two treatment groups, submucosal injection （normal saline was injected into the submucosal area under the lesion before APC） and direct APC. Treatment-related complications were recorded. Six weeks and 6 months later,patients underwent endoscopy and pathology follow-ups. The chi-square test was used to compare the efficiency of the two groups. Results A total of 62 elderly patients were included in the study from October 2013 through April 2014. Fifty-one patients with 62 lesions underwent endoscopy follow-ups after 6 weeks and the effective ratio of the treatment was 91.9% （57/62）. Forty-three patients with 45 lesions underwent endoscopy follow-ups after 6 months, and the effective ratio of the treatment was 93.3% （42/45）. The recurrence rate was higher in moderate atypical hyperplasia （6/14）, and there were no significant differences in the submucosal injection before APC and direct APC （P 〉 0.05）. Treatment-related complications were less severe and acceptable,and there was no bleeding or perforation. Conclusion APC is safe and effective in elderly patients with gastric low-grade intraepithelial neoplasia （LGIN）,and personalized endoscopy follow-ups should be performed.