消化道早期肿瘤的内镜下治疗临床疗效和安全性观察

摘要

目的 进一步探讨内镜下行EMR(Endoscopic mucosal resection,内镜黏膜切除术)和ESD(Endoscopic submucosal dissection,内镜黏膜剥离术)治疗消化道早期肿瘤的临床疗效和安全性.方法 将2009年以来我院收治的经内镜和病理组织学明确诊断为重度不典型增生、癌前病变和原位癌的消化道早期肿瘤的病例分为两组,分别进行EMR和ESD治疗.比较两组手术时间和并发症发生率；治疗2周后,内镜复查,观察治疗效果.结果 行EMR和ESD的病例(各30例)均顺利完成,所有病例均完整回收标本进行组织病理学检测,两组均未出现穿孔；EMR组发生出血2例,出血率6.67％( 2/30)；ESD组发生17例出血,出血率56.67％( 17/30)；两组出血率比较,差异有统计学意义(x2=17.33,P＜0.05).临床疗效观察:EMR组7例有病灶残留,残留率23.33％ (7/30); ESD组2例有病灶残留,残留率6.67％( 2/30)；两组病灶残留率比较,差异有统计学意义(x2=3.91,P＜0.05).结论 EMR操作相对简单、手术时间较短、容易被掌握、出血穿孔率较低；而ESD操作技术比较复杂,要求熟练程度高,手术时间较长,容易发生出血及穿孔.对于消化道早期肿瘤,在内镜下行EMR和ESD就可达到根治目的,既可保证病变完全切除,又能提高患者生存质量,并可达到外科手术相似的效果.%Objective To further explore the clinical efficacy and safety of endoscopic mucosal resection ( EMR ) and endoscopic submucosal dissection ( ESD ) for early gastrointestinal tumors.Methods The patients with histopathologically confirmed early gastrointestinal tumors including severe atypical hyperplasia,precancerous lesions,and carcinoma in situ were divided into two groups,receiving either EMR or ESD.The surgical duration and incidence rate of complications were compared between the two groups:and the efficacy was observed endoscopically 2 weeks after treatment.Results EMR was successfully performed on 30 patients,so was ESD on another 30.The specimens from all the patients were collected for histopathological detection.Hemorrhage developed in two patients undergoing EMR ( 6.67％ ) but in 17 undergoing ESD ( 56.67％ ),with a significant difference ( x2=17.33,P＜ 0.05 ).The residual rate of lesion differed significantly between EMR and ESD ( 7 cases vs.2 cases or 23.33％ vs.6.67％; x2=3.91,P＜ 0.05 ).Conclusions EMR is relatively simple and easy to operate and has shorter duration and lower rates of hemorrhage and perforation; ESD is more complicated,needs greater skills,has longer surgical duation,and is prone to bleeding and perforation.Early gastrointestinal tumors can be cured by EMR or ESD.The procedures can not only ensure complete resection of lesions,but also improve quality of life in patients and achieve a similar effect with conventional surgical treatment.