隧道式内镜黏膜下剥离术对早期食管癌和癌前病变的远期疗效评价

Long-term efficacy evaluation of tunnel-type endoscopic submucosal dissection for early esophageal cancer and precancerous lesions

目的探讨隧道式内镜黏膜下剥离术(ESTD)对早期食管癌和癌前病变的远期疗效。方法纳入本院2018年5月~2019年5月早期食管癌和癌前病变且符合内镜下黏膜剥离术(ESD)手术指征的患者95例。随机分为观察组(48例)和对照组(47例),对照组接受传统ESD治疗,观察组接受ESTD治疗。比较两组手术指标、切除效果、并发症及术后1、2和3年生存率和复发率差异。结果观察组剥离面积、剥离速度均大于对照组,剥离完成时间、手术时间均短于对照组(P<0.05);根治性切除率高于对照组(P<0.05);两组术后并发症发生率差异无统计学意义(P>0.05);观察组术后3年累计复发率低于对照组(P<0.05)。结论对于早期食管癌和癌前病变患者,ESTD剥离速度更快、根治性切除率更高,且可发挥更显著的远期疗效,有效降低复发风险。

Objective To investigate the long-term effect of endoscopic submucosal tunnel dissection(ESTD)on early esophageal cancer and precancerous lesions.Methods From May 2018 to May 2019,95 patients with early esophageal cancer and precancerous lesions meeting the surgical indications of endoscopic mucosal dissection(ESD)were enrolled in our hospital.They were randomly divided into observation group(48 cases)and control group(47 cases).The control group received traditional ESD treatment,and the observation group received ESTD treatment.The postoperative indexes,resection effect,complications,1,2 and 3 year survival rate and recurrence rate were compared between the two groups Results The area and speed of dissection in the observation group were higher than those in the control group,and the time of complete dissection and operation were shorter than those in the control group(P<0.05).The radical resection rate in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The 3 years cumulative recurrence rate in the observation group was lower than that in the control group(P<0.05).Conclusion For patients with early esophageal cancer and precancerous lesions,compared with traditional ESD,ESTD has faster stripping speed,shorter operation time,higher radical resection rate,and more significant long-term efficacy,effectively reduce the risk of recurrence.