消化道内镜诊治早期癌前病变62例回顾性分析
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摘要
目的分析经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)诊治消化道早期癌前病变患者疗效和预后。方法 2013—2016年舟山市妇幼保健院共收治62例疑似消化道癌肿患者,其中,男性41例,女性21例,平均(58.5±6.2)岁。患者均经ESD进行诊断和治疗,术后病理结果确诊为早期癌前病变。考察ESD诊断和治疗的效果,并发症情况和患者的预后。结果病变均在黏膜、黏膜下层,部位分别在食管17例(27.42%)、胃29例(46.77%)、结肠16例(25.81%),其中多为食管中段(10例,58.82%)。病理分型分别为Ⅰ型3例(4.84%)、Ⅱ型59例(95.16%),其中多为Ⅱb(28例,47.16%)。病灶完全切除率为95.16%(59/62),治愈性切除率为90.32%(56/62)。术中出血1例(1.61%),穿孔2例(3.23%),术后胸骨后疼痛2例(3.23%),腹痛1例(1.61%),均经抗感染、抑酸等治疗后痊愈。随访第6个月无失访患者,患者的进食不适、吞咽困难等症状均得到明显地缓解(分别为21例,33.87%和18例,29.03%)。复发1例(1.61%),经再次ESD术后痊愈出院。结论 ESD诊治消化道早期癌前病变的切除率高,并发症和术后复发率较低,可以作为微创诊疗消化道癌前病变的首选手段。
Objective To evaluate the effect and outcome of endoscopic submucosal dissection( ESD) in the diagnosis and treatment of early gastrointestinal precancerous lesions. Methods From 2013 to 2016,62 cases of suspected gastrointestinal cancer patients in our hospital were enrolled into the study,including 41 cases of male and 21 cases of female.The average age was( 58. 5 ± 6. 2) years. All patients were diagnosed and treated by ESD,which were confirmed by pathological findings as early precancerous lesions. The effect of ESD in the diagnosis and treatment was evaluated; the complications and prognosis of patients were observed. Results The lesions were all located in the mucosa and submucosa. The lesions were located in esophagus( 17 cases,27. 42%),stomach( 29 cases,46. 77%) and colon( 16 cases,25. 81%),respectively. Most of them were middle esophagus( 10 cases,58. 82%). The pathological type Ⅰ was 4. 84%( n = 3) and type Ⅱ was 95. 16%( n = 59),in most of the patients it was of Ⅱb( 28 cases,45. 16%). The total resection rate was95. 16%( 59/62),and the cure rate was 90. 32%( 56/62). The incidence of the complications was bleeding in 1 case( 1. 61%),perforation in 2 cases( 3. 23%),postoperative chest pain in 2 cases( 3. 23%),abdominal pain in 1 case( 1. 61%),they were all cured after anti-infection and antacid treatment. The sixth months follow-up showed that there was no lost patients,the patients with eating discomfort and dysphagia symptoms were obviously relieved( 21 cases,33. 87%; 18 cases,29. 03% respectively). Recurrence was found in 1 case( 1. 61%),and was cured after ESD. Conclusion ESD is effective in the diagnosis and treatment of early gastric precancerous lesions,with the low incidence of the complications and postoperative recurrence rate. It can be used as the first choice for minimally invasive diagnosis and treatment of precancerous lesions of digestive tract.
Objective To evaluate the effect and outcome of endoscopic submucosal dissection( ESD) in the diagnosis and treatment of early gastrointestinal precancerous lesions. Methods From 2013 to 2016,62 cases of suspected gastrointestinal cancer patients in our hospital were enrolled into the study,including 41 cases of male and 21 cases of female.The average age was( 58. 5 ± 6. 2) years. All patients were diagnosed and treated by ESD,which were confirmed by pathological findings as early precancerous lesions. The effect of ESD in the diagnosis and treatment was evaluated; the complications and prognosis of patients were observed. Results The lesions were all located in the mucosa and submucosa. The lesions were located in esophagus( 17 cases,27. 42%),stomach( 29 cases,46. 77%) and colon( 16 cases,25. 81%),respectively. Most of them were middle esophagus( 10 cases,58. 82%). The pathological type Ⅰ was 4. 84%( n = 3) and type Ⅱ was 95. 16%( n = 59),in most of the patients it was of Ⅱb( 28 cases,45. 16%). The total resection rate was95. 16%( 59/62),and the cure rate was 90. 32%( 56/62). The incidence of the complications was bleeding in 1 case( 1. 61%),perforation in 2 cases( 3. 23%),postoperative chest pain in 2 cases( 3. 23%),abdominal pain in 1 case( 1. 61%),they were all cured after anti-infection and antacid treatment. The sixth months follow-up showed that there was no lost patients,the patients with eating discomfort and dysphagia symptoms were obviously relieved( 21 cases,33. 87%; 18 cases,29. 03% respectively). Recurrence was found in 1 case( 1. 61%),and was cured after ESD. Conclusion ESD is effective in the diagnosis and treatment of early gastric precancerous lesions,with the low incidence of the complications and postoperative recurrence rate. It can be used as the first choice for minimally invasive diagnosis and treatment of precancerous lesions of digestive tract.
引文
[1]凌安生,朱芳来,伍平,等.内镜黏膜下剥离术治疗食管早期癌及癌前病变的疗效[J].中南大学学报(医学版),2016,41(1):71-74.
[2]Gao J,Feng-Ting WU,Xian AL,et al.Comparative study between endoscopic ultrasongraphy-assisted endoscopic mucosal resection and routine endoscopic mucosal resection treatment of esophageal precancerous lesions[J].Journal of Hainan Medical University,2016,22(21):66-68.
[3]张震.内镜下黏膜切除术及内镜黏膜下剥离术治疗上消化道早期癌及癌前病变[J].中国实用医药,2015,10(36):46-47.
[4]贺亚宁,王志勇,马菊妹,等.内镜黏膜下剥离术治疗消化道早期癌及癌前病变45例临床护理[J].齐鲁护理杂志,2014,20(8):9-11.
[5]张荣,田叶红,张利云,等.内镜黏膜下剥离术治疗上消化道早癌及癌前病变并发术中出血危险因素分析[J].山西医科大学学报,2016,47(4):352-355.
[6]李志海,郭红节.内镜下黏膜剥离术治疗上消化道早期癌和癌前病变的疗效分析[J].现代消化及介入诊疗,2016,21(2):271-273.
[7]刘波颖,汪福群,王胜炳.内镜下黏膜剥离术治疗上消化道早期癌和癌前病变疗效观察[J].实用医学杂志,2015,31(14):2346-2348.
[8]朱晓妍,朱靖宇,申星杰,等.内镜黏膜下剥离术治疗消化系统早癌及癌前病变的临床疗效[J].现代生物医学进展,2016,16(20):3873-3875.
[9]蒋良君,阳学风,傅念,等.内镜黏膜下剥离术与传统外科手术治疗消化道早期癌及癌前病变的疗效比较[J].中国老年学,2016,36(12):3007-3008.
[10]Jin HL.Endoscopic submucosal dissection for early esophageal cancer and precancerous lesions[J].Word Chinese Journal of Digestology,2015,23(4):89-91.
[11]何祎,陆薇,童珠红.早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较[J].中国内镜杂志,2016,22(10):66-69.
[12]韦虹,熊鹰,曾理,等.内镜下黏膜剥离术治疗消化道早期肿瘤及癌前病变[J].深圳中西医结合杂志,2016,26(8):14-16.
[13]Jia JC,Duan XF,Emergency DO.Clinical study on the efficacy of endoscopic ultrasound assisted endoscopic submucosal dissection in treating esophageal precancerous lesions[J].China Journal of Endoscopy,2015,25(7):105-107.
[14]邓燕,方慧祺,伍红英.内镜黏膜下剥离术治疗消化道早期癌及癌前病变的疗效[J].中南大学学报:医学版,2016,17(11):15-17.
[15]徐杲,苏江,华婷琰,等.内镜黏膜下剥离术及外科手术治疗早期胃癌的预后效果评估[J].临床消化病杂志,2016,28(2):91-94.
[2]Gao J,Feng-Ting WU,Xian AL,et al.Comparative study between endoscopic ultrasongraphy-assisted endoscopic mucosal resection and routine endoscopic mucosal resection treatment of esophageal precancerous lesions[J].Journal of Hainan Medical University,2016,22(21):66-68.
[3]张震.内镜下黏膜切除术及内镜黏膜下剥离术治疗上消化道早期癌及癌前病变[J].中国实用医药,2015,10(36):46-47.
[4]贺亚宁,王志勇,马菊妹,等.内镜黏膜下剥离术治疗消化道早期癌及癌前病变45例临床护理[J].齐鲁护理杂志,2014,20(8):9-11.
[5]张荣,田叶红,张利云,等.内镜黏膜下剥离术治疗上消化道早癌及癌前病变并发术中出血危险因素分析[J].山西医科大学学报,2016,47(4):352-355.
[6]李志海,郭红节.内镜下黏膜剥离术治疗上消化道早期癌和癌前病变的疗效分析[J].现代消化及介入诊疗,2016,21(2):271-273.
[7]刘波颖,汪福群,王胜炳.内镜下黏膜剥离术治疗上消化道早期癌和癌前病变疗效观察[J].实用医学杂志,2015,31(14):2346-2348.
[8]朱晓妍,朱靖宇,申星杰,等.内镜黏膜下剥离术治疗消化系统早癌及癌前病变的临床疗效[J].现代生物医学进展,2016,16(20):3873-3875.
[9]蒋良君,阳学风,傅念,等.内镜黏膜下剥离术与传统外科手术治疗消化道早期癌及癌前病变的疗效比较[J].中国老年学,2016,36(12):3007-3008.
[10]Jin HL.Endoscopic submucosal dissection for early esophageal cancer and precancerous lesions[J].Word Chinese Journal of Digestology,2015,23(4):89-91.
[11]何祎,陆薇,童珠红.早期结直肠癌及癌前病变患者经内镜下黏膜切除术与黏膜剥离术治疗的疗效比较[J].中国内镜杂志,2016,22(10):66-69.
[12]韦虹,熊鹰,曾理,等.内镜下黏膜剥离术治疗消化道早期肿瘤及癌前病变[J].深圳中西医结合杂志,2016,26(8):14-16.
[13]Jia JC,Duan XF,Emergency DO.Clinical study on the efficacy of endoscopic ultrasound assisted endoscopic submucosal dissection in treating esophageal precancerous lesions[J].China Journal of Endoscopy,2015,25(7):105-107.
[14]邓燕,方慧祺,伍红英.内镜黏膜下剥离术治疗消化道早期癌及癌前病变的疗效[J].中南大学学报:医学版,2016,17(11):15-17.
[15]徐杲,苏江,华婷琰,等.内镜黏膜下剥离术及外科手术治疗早期胃癌的预后效果评估[J].临床消化病杂志,2016,28(2):91-94.