内镜黏膜下剥离术与外科手术治疗食管早癌及癌前期病变的疗效比较

Comparison of endoscopic submucosal dissection and surgical treatment of early esophageal cancer and precancerous lesions

目的比较内镜黏膜下剥离术(ESD)和外科手术治疗食管早癌及癌前病变的有效性及安全性。方法选择2011年10月至2013年10月在深圳市第二人民医院消化内科接受治疗的食管早癌及癌前病变患者64例作为研究对象,按随机数表法分为ESD组(34例)和外科手术组(30例),分别给予内镜黏膜下剥离术与普通外科手术治疗,比较两种方法的有效性及安全性。结果 ESD组患者的手术时间和住院天数分别为(82.7±18.1)min和(9.36±3.7)d,明显短于外科手术组的(197.7±24.6)min和(19.8±5.1)d,差异均有统计学意义(P>0.05);ESD组患者的整块切除率、完整切除率及治愈性切除率分别为100.0%、97.1%和97.1%,与外科组的100.0%、96.7%和96.7%比较,差异均无统计学意义(P>0.05);ESD组患者术后并发症发生率为11.7%,明显低于外科手术组的36.7%,差异有统计学意义(P<0.05);两组患者术后随访均未出现原发病灶复发及转移。结论与传统外科手术相比,ESD治疗食管早癌及癌前病变的临床效果更好、术后并发症更少,安全性更高,值得临床推广。

Objective To compare the efficacy and safety of the endoscopic submucosal dissection（ESD） and surgical treatment of early esophagus cancer and precancerous lesions. Methods A total of 64 cases of patients with early esophageal cancer and precancerous lesions, who admitted to Department of Gastroenterology of the Second People＇s Hospital of Shenzhen from October 2011 to October 2013, were selected and randomly divided into the endoscopic submucosal dissection（ESD） group（34 cases） and the surgery group（30 cases）, respectively treating with endoscopic submucosal dissection and general surgical treatment. The efficacy and safety of the two methods were compared. Results The operative time and hospitalization days of the ESD group were respectively（82.7±18.1） min and（9.36±3.7）d, which were significantly shorter than corresponding（197.7±24.6） min and（19.8±5.1） d of the surgery group（P〈0.01）.There was no significant difference between the ESD group（100.0%, 97.1% and 97.1%） and the surgical group（100.0%, 96.7% and 96.7%） in the total resection rate, complete resection rate and curative resection rate（P〈0.05）. The incidence of postoperative complications in the ESD group was 11.7%, which was significantly lower than 36.7% in the surgical group（P〈0.05）. There was no recurrence and metastasis of primary lesions in the two groups. Conclusion Compared with the conventional operation, ESD has good clinical effect, less complications, high safety in the treatment of early esophageal cancer and precancerous lesions, which is worthy of clinical promotion.