内镜下黏膜剥离术与隧道法内镜黏膜下剥离术治疗早期食管癌及癌前病变效果对比研究

Comparative Analysis between Endoscopic Submucosal Dissection and Endoscopic Submucosal Tunnel Dissection in Treatment of Patients with Early Esophageal Cancer and Precancerous Lesions

目的对比内镜下黏膜剥离术(ESD)与隧道法内镜黏膜下剥离术(ESTD)治疗早期食管癌及癌前病变的临床价值。方法回顾性分析2013年9月—2017年9月遂宁市中心医院收治的食管癌早癌及癌前病变78例的临床资料,根据手术方法分为A组38例和B组40例。A组给予ESD治疗,B组给予ESTD治疗。记录并比较2组手术情况、病灶切除情况及术中或术后并发症的发生率和随访情况。结果 B组剥离面积和单位时间切除率均大于A组,而手术时间和术后住院时间短于A组,术后并发症发生率低于A组(P<0.05)。随访1年,A组1例于出院后6个月时复发,再次入院采用ESD治疗后愈合良好,其余均未发生原发病灶的残留、复发及转移。结论 ESD和ESTD治疗早期食管癌及癌前病变临床疗效和预后效果较好,但ESTD剥离速度更快且安全性更高,更适用于病灶体积较大患者。

Objective To compare clinical value between endoscopic submucosal dissection(ESD)and endoscopic submucosal tunnel dissection(ESTD)in treatment of patients with early esophageal cancer and precancerous lesions.Methods Clinical data of 78 patients with esophageal cancer and precancerous lesions admitted during September 2013 to September 2017 was retrospectively analyzed,and the patients were divided into group A(n=38)and group B(n=40)according to operative methods.Group A was treated with ESD,while group B was treated with ESTD.Conditions of operations,lesion excision,intraoperative and postoperative complication incidence and follow-up were recorded and compared in two groups.Results In group B,values of stripping area and resection rate in unit time were significantly higher,while operative time and postoperative hospital stay were significantly shorter,and incidence rate of postoperative complications was significantly lower than those in group A(P<0.05).With 1 year of follow-up,1 patient in group A relapsed in 6 months after discharge,and with the patient healed well after ESD therapy in admission again,and the rest of patients had no residual,recurrence or metastasis of primary lesion.Conclusion ESD and ESTD have good clinical efficacy and prognosis in treatment of patients with early esophageal cancer and precancerous lesions,whereas ESTD may achieve faster stripping speed and better security,and therefore it is more suitable for patients with larger area lesion.