内镜下黏膜剥离术治疗早期胃癌42例
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摘要
目的探讨超声内镜联合放大内镜结合窄带成像(magnifying endoscopy with narrow-band imaging,MENBI)在早期胃癌诊断中的临床价值及经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌的临床疗效。方法回顾性分析经ESD术治疗的42例早期胃癌患者胃镜下表现和病理检查结果情况。结果 42例患者均成功接受ESD术,手术时间20~120 min,(54.89±27.05)min。整块切除率为100%,癌变组织完整切除率为92.9%(39/42),治愈性切除率78.5%(33/42)。随访36个月,生存率为92.9%(39/42)。术后出血占2.4%(1/42,胃窦),溃疡占16.7%(7/42),溃疡出血占4.8%(2/42)。超声下病变深度与术后病理检查结果比较一致性较好,Kappa值为0.867(P<0.01)。ME-NBI观察血管情况与术后组织病理检查结果比较,差异无统计学意义(P=0.473),但观察腺管结构差异具有统计学意义(P=0.015)。ME-NBI联合超声内镜检测侵犯深度与术后病理侵犯深度的一致性较高,Kappa值为0.879(P<0.01)。结论 ME-NBI联合超声内镜探测病变浸润深度与病理检测一致性比单独使用超声内镜高,对提高早期胃癌的诊断率有很大帮助。在治疗上,ESD术安全性及可靠性均较高。
Objective To investigate the clinical value of endoscopic ultrasonography combined with magnifying endoscopy with narrow-band imaging( ME-NBI) in the diagnosis of early gastric cancer,as well as the clinical curative effect of endoscopic submucosal dissection( ESD) in the treatment of early gastric cancer. Methods The clinical manifestation under gastroscope and the pathological results of 42 early gastric cancer patients after ESD treatment were retrospectively analyzed. Results Forty-two cases were successfully treated with ESD. The operation time ranges between 20 to 120( 54. 89 ± 27. 05) min,with a block resection rate of 100%. The complete resection rate of cancerous tissue was 92. 9%( 39/42),and the curative resection rate was 78. 5%( 33/42). All patients were followed up regularly for 36 months,and the survival rate was 92. 9%( 39/42). After the surgery,the rate of postoperative bleeding was 2. 4%( 1/42,gastric antrum),the rate of ulcer was 16. 7%( 7/42),and the rate of ulcer bleeding was 4. 8%( 2/42). In the determination of lesion depth,endoscopic ultrasonography displayed good consistency with postoperative pathological test,with a kappa value of 0. 867( P < 0. 01). Similarly,regarding to the examination of vascular condition,ME-NBI has no statistically significant difference compared with postoperative histopathology( P = 0. 473). However,the results of gland structure were statistically significant between the two methods( P = 0. 015). Finally,there was a high consistency between ME-NBI combined with endoscopic ultrasonography and postoperative pathological tests in the analyses of invasion depth,and the kappa value was 0. 879( P < 0. 01). Conclusion ME-NBI combined with endoscopic ultrasonography had higher consistency than using endoscopic ultrasonography when comparing with pathological examination in detecting invasion depth. ME-NBI combined with endoscopic ultrasonography can significantly improve the diagnosis rates of early gastric cancer,and ESD has satisfactory safety and reliability in the treatment of early gastric cancer.
Objective To investigate the clinical value of endoscopic ultrasonography combined with magnifying endoscopy with narrow-band imaging( ME-NBI) in the diagnosis of early gastric cancer,as well as the clinical curative effect of endoscopic submucosal dissection( ESD) in the treatment of early gastric cancer. Methods The clinical manifestation under gastroscope and the pathological results of 42 early gastric cancer patients after ESD treatment were retrospectively analyzed. Results Forty-two cases were successfully treated with ESD. The operation time ranges between 20 to 120( 54. 89 ± 27. 05) min,with a block resection rate of 100%. The complete resection rate of cancerous tissue was 92. 9%( 39/42),and the curative resection rate was 78. 5%( 33/42). All patients were followed up regularly for 36 months,and the survival rate was 92. 9%( 39/42). After the surgery,the rate of postoperative bleeding was 2. 4%( 1/42,gastric antrum),the rate of ulcer was 16. 7%( 7/42),and the rate of ulcer bleeding was 4. 8%( 2/42). In the determination of lesion depth,endoscopic ultrasonography displayed good consistency with postoperative pathological test,with a kappa value of 0. 867( P < 0. 01). Similarly,regarding to the examination of vascular condition,ME-NBI has no statistically significant difference compared with postoperative histopathology( P = 0. 473). However,the results of gland structure were statistically significant between the two methods( P = 0. 015). Finally,there was a high consistency between ME-NBI combined with endoscopic ultrasonography and postoperative pathological tests in the analyses of invasion depth,and the kappa value was 0. 879( P < 0. 01). Conclusion ME-NBI combined with endoscopic ultrasonography had higher consistency than using endoscopic ultrasonography when comparing with pathological examination in detecting invasion depth. ME-NBI combined with endoscopic ultrasonography can significantly improve the diagnosis rates of early gastric cancer,and ESD has satisfactory safety and reliability in the treatment of early gastric cancer.
引文
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[7]陈燕,吾红光,潘文胜.直肠腺瘤内镜黏膜下剥离术后颈部纵隔广泛气肿一例[J].实用肿瘤杂志,2017,32(3):273-275.
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[9]Toyonaga T,Man IM,East JE,et al.1,635 Endoscopic submucosal dissection cases in the esophagus,stomach,and colorectum:complication rates and long-term outcomes[J].Surg Endosc,2013,27(3):1000-1008.
[2]Nakayoshi T,Tajiri H,Matsuda K,et al.Magnifying endoscopy combined with narrow band imaging system for early gastric cancer[J].Endoscopy,2004,36(12):1080-1084.
[3]Zhou C,Tsai TH,Lee HC,et al.Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography(with videos)[J].Gastrointest Endosc,2012,76(1):32-40.
[4]Tajiri H,Doi T,Endo H,et al.Routine endoscopy using a magnifying endoscope for gastric cancer diagnosis[J].Endoscopy,2002,34(10):772.
[5]Li HY,Dai J,Xue HB,et al.Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions:a prospective study[J].Gastrointest Endosc,2012,76(6):1124-1132.
[6]Uedo N,Ishihara R,Iishi H,et al.A new method of diagnosing gastric intestinal metaplasia:narrow-band imaging with magnifying endoscopy[J].Endoscopy,2006,38(8):819.
[7]陈燕,吾红光,潘文胜.直肠腺瘤内镜黏膜下剥离术后颈部纵隔广泛气肿一例[J].实用肿瘤杂志,2017,32(3):273-275.
[8]孙曦,张修礼,卢忠生,等.消化道早癌及癌前病变内镜下切除与外科手术切除的效价比对比研究[J].中华消化内镜杂志,2013,30(1):15-17.
[9]Toyonaga T,Man IM,East JE,et al.1,635 Endoscopic submucosal dissection cases in the esophagus,stomach,and colorectum:complication rates and long-term outcomes[J].Surg Endosc,2013,27(3):1000-1008.