内镜下黏膜剥离术和内镜下黏膜切除术治疗早期Ⅱ型食管胃交界处肿瘤的疗效对比

Analysis of the efficacy of endoscopic submucosal dissection and endoscopic mucosal resection in the treatment of early typeⅡesophagogastric junction neoplasm

目的探讨内镜下黏膜剥离术(ESD)和内镜下黏膜切除术(EMR)治疗早期Ⅱ型食管胃交界处肿瘤的远期疗效。方法回顾性分析2017年4月~2019年8月于我院因早期Ⅱ型食管胃交界处肿瘤行内镜手术治疗的患者120例,根据手术方式不同分为ESD组(n=64)和EMR组(n=56)。术后定期随访,比较两组患者手术时间、住院时间、肿瘤切除率、术后并发症发生率、肿瘤复发率及生存率。结果EMR组患者手术时间及住院时间均明显低于ESD组(P<0.05)。EMR组术后并发症发生率(5.36%)明显低于ESD组(18.75%)(P<0.05)。ESD组的R0切除率(92.19%)及整块切除率(95.31%),明显高于EMR组的76.29%与80.36%(均P<0.05)。EMR组的局部复发率(12.50%)及远处复发率(10.71%),明显高于ESD组的1.56%与0.0%(均P<0.05)。结论ESD治疗早期Ⅱ型食管胃交界处肿瘤相对EMR手术时间较长,术后并发症发生率较高,但是手术疗效更好。

Objective To compare the efficacy of endoscopic mucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early typeⅡesophagogastric junction neoplasm.Methods A retrospective analysis of 120 patients who underwent endoscopic surgery for early typeⅡesophagogastric junction tumors in our hospital from April 2017 to August 2019 were divided into ESD group(n=64)and EMR group(n=56).Regular follow-up after operation was performed to compare the operation time,hospital stay,tumor resection rate,postoperative complication rate,tumor recurrence rate and survival rate of the two groups.Results The operation time and hospitalization time of the EMR group were significantly lower than that of the ESD group,and the difference was statistically significant(P<0.05).The postoperative complication rate in the EMR group was 5.36%,which was significantly lower than the 18.75%in the ESD group,and the difference was statistically significant(P<0.05).The R0 resection rate and enbloc resection rate in the ESD group were 92.19%and 95.31%,respectively,which were significantly higher than the 76.29%and 80.36%in the EMR group.The differences were statistically significant(P<0.05).The local recurrence rate and the remote recurrence rate of the EMR group were higher than the ESD group,and the difference was statistically significant(P<0.05).Conclusion ESD treatment of early typeⅡesophagogastric junction neoplasm takes longer time than EMR surgery,and has a higher incidence of postoperative complications,but the surgical effect is better.