内镜黏膜下剥离术治疗早期胃癌

摘要

Objective Endoscopic suhmucosal dissection (ESD) is a new diagnostic and therapeutical technique for early gastric cancer (EGC).The aim of this study was to evaluate the efficacy and safety of ESD for EGG.Methods The data of patients who underwent ESD for EGCs from July 2007 to December 2007 were analyzed retrospectively.One-piece resection rate,histologically complete resection rate (the lateral and vertical margins were free of cancer),operation time,complications,post-ESD ulcer-healing rates and local recurrence were assessed.Results A total of 21 EGCs in 20 consecutive patients were treated with ESD.The median age was 56.4 years (range 37-75 years) and the male/female ratio was 1.9(13/7).Out of 21 lesions,20 (95.2%) were resected in one piece.The rate for one-piece resection with tumor-free margins was 90.5% (19/21).Acute minor bleeding during the ESD procedure occurred in 4.8% (1/21).Post-ESD epigastric pain rate was 76.2%(16/21).No acute major bleeding, delayed bleeding and perforation occurred.The median operation time was 50.4 min (range 45-200 min).The pest-ESD ulcer-healing rates was 100% after 8 weeks of oral esomeprazole.After a follow-up with median time of 9.2 months (range 8-12 months),none of the patients experienced residual/local recurrence of early gastric cancer.Conclusion ESD has the advantage of increasing one-piece resection rate and histologically curative resection rates.ESD is a safe and effective treatment for EGC.%目的 探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的有效件及安全性.方法 对20例早期胃癌患者共21处病灶进行ESD治疗,观察治疗的情况及效果.结果 21处病灶一次性整块切除率为95.2%(20/21),组织学治愈性切除率为90.5%(19/21).平均手术时间50.4 min.急性少量出血率4.8%(1/21),术后腹痛发生率为76.2%(16/21),未发生急性大量出血、穿孔、术后延迟出血.2个月时复查胃镜,溃疡愈合率100%.平均随访9.2个月(8～12个月),局部无残留、复发及异时病灶发生.结论 ESD町提高一次性完整切除率和组织学治愈性切除率,是一种治疗早期胃癌的安全有效的方法.