内镜黏膜下剥离术治疗早期胃癌及癌前病变36例临床分析

Clinical value of endoscopic submucosal dissection for early gastric cancer (36 cases)

摘要:

目的  评估内镜黏膜下剥离术（ESD）治疗早期胃癌（EGC）及癌前病变的有效性和价值。方法  该院消化医学中心2012年1月-2014年1月36例EGC及癌前病变，共43处病灶，行ESD治疗，其中31处重度不典型增生、11处黏膜内癌、1处黏膜下癌。病变7处位于上段胃、15处中段胃及21处下段胃。内镜分型包括：Ⅰ（7）、Ⅱa（14）、Ⅱb（4）、Ⅱc（11）、Ⅱa+Ⅱc（4）及Ⅱc+Ⅱa（3）。结果  完整切除率93.0%，治愈性切除率90.7%。病灶平均直径3.4 cm（1.3～7.5 cm），1例病变R1切除，3处病变ESD术中穿孔使用金属夹封闭成功，1例迟发性出血内镜下止血成功，1例追加外科手术。无1例发生严重并发症。结论  ESD治疗EGC具有较高的完整切除率和治愈性切除率。

Abstract:

Abstract: Objective To evaluate the clinical efficacy and value of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Methods Clinical data of 36 EGC patients were collected from Jan. 2012 to Jan. 2014. 43 lesions were resected under endoscopy by submucosal dissection (ESD), including 31 severe dysplasia, 11 cancer intramucosal and 1 cancer submucosa. The location of tumors included 7 upper stomach, 15 middle stomach and 21 lower stomach. The endoscopic types were including: Ⅰ(7), Ⅱa (14), Ⅱb (4), Ⅱc (11), Ⅱa+Ⅱc (4) and Ⅱc+Ⅱa (3). Results Enbloc or complete and curative resection rates were achieved 93.0 % and 90.7 %. The average maximum tumor size was 3.4 cm (1.3 ～ 7.5 cm). 1 case of R1 resection, 3 cases occurred perforation during ESD procedures, were closed by metal clips. 1 case delayed bleeding was cured. Conclusion ESD was an effective treatment for EGCs with high ratio of en bloc or complete and curative resection.