上消化道外科术后行内镜黏膜下剥离术治疗早期癌的临床应用

Clinical application of endoscopic submucosal dissection for early cancer in postoperative upper gastrointestinal tract

目的评估上消化道外科术后行内镜黏膜下剥离术(ESD)治疗早期癌的安全性及疗效。方法回顾性分析上消化道外科术后行ESD治疗早期癌患者12例并设为病例组,同时另设2个对照组:外科组:上消化道外科术后因残胃早期癌再次外科手术治疗10例;正常消化道结构组:采用1:5匹配选择正常结构对照病例60例。比较病例组和对照组间的患者特征、内镜下表现及疗效指标。结果外科术后重建的上消化道行ESD治疗操作空间狭小,术前超声胃镜于病灶处未探及缝线。病例组在整块切除率、完整切除率、术中大出血发生率,术后并发症发生率分别与对照组比较,差异均无统计学意义(P均>0.05)。病例组中位操作时间、中位术中出血量、中位禁食时间、中位抗感染治疗时间、中位住院时长均短于外科组(z分别=-2.70、-3.91、-3.10、-2.97、-2.99,P均<0.05)。病例组中位切除病灶大小、中位操作时间、中位术中出血量、中位禁食时间、中位抗感染治疗时间、中位住院时长、中位住院花费等疗效指标与正常消化道结构组比较,差异均无统计学意义(z分别=-0.76、-0.87、-1.46、-0.13、-0.02、-0.58、-1.27,P均>0.05)。结论上消化道外科术后行ESD治疗早期癌,对于符合适应证的患者是安全有效的。

Objective To evaluate the safety and clinical effect of endoscopic submucosal dissection（ESD）for early cancerin postoperative and reconstructed upper gastrointestinal tract. Method Clinical results of ESD for early cancer inpostoperative and reconstructed upper gastrointestinal tract of 12 patients were retrospectively analyzed as cases group. Twocontrol groups were set up： surgery group contained 10 patients treated by surgery for early remnant gastric cancer and normalstructure group contained 60 patients with intact upper gastrointestinal tract treated by ESD matched by 1：5. The patients’characteristics,endoscopic and histopathological findings,and outcome measurements were compared. Results The workingspace of ESD in postoperative and reconstructed upper gastrointestinal tract was limited. No stump line was detected in thepreoperative endoscopic ultrasonography. There were no significant differences in the rate of complete resection,intraoperativemassive hemorrhage,and postoperative complication between cases group and control groups separately（P〉 0.05）. Themedian procedure time,median amount of bleeding,median duration of fasting,median duration of anti-infective therapy,median duration of hospital stay of cases group were significantly superior to surgery group（z = -2.70,-3.91,-3.10,-2.97,-2.99,P〈0.05）.There were no significant differences in median excised lesion size,median procedure time,median amountof bleeding,median duration of fasting,median duration of anti-infective therapy,median duration of hospital stay,and medianhospitalization expense between cases group and normal structure group（z = -0.76,-0.87,-1.46,-0.13,-0.02,-0.58,-1.27,P〉0.05）. Conclusion Within the range of indications,ESD for early cancer in postoperative and reconstructed uppergastrointestinal tract was a feasible and effective therapeutic method.