CAJ | 학술논문

目的将内镜黏膜下剥离术(ESD)和内镜黏膜切除术(EMR)进行比较,评价ESD治疗胃食管连接部(GEJ)癌前病变及早癌的有效性及安全性.方法分析28例经ESD治疗和51例经EMR治疗的GEJ癌前病变及早癌患者的临床资料,比较两种方法病灶整块切除率、组织学治愈性切除率、手术时间、并发症、复发率等.结果 ESD整块切除率为92.9％ (26/28),治愈切除率为78.6％(22/28)均优于EMR组的45.1％(23/51)和43.1％(22/51),两者差异有统计学意义(P均＜0.05).局部原位复发率ESD组为3.6％(1/28),明显低于EMR组的19.6％( 10/51) (P ＜0.05).术后延迟出血、穿孔、狭窄等严重并发症的发生ESD组与EMR组之间差异无统计学意义.平均手术时间ESD为(64.3±27.1)min,明显长于EMR( 27.6±14.1)min(P ＜0.05).结论 ESD和EMR相比,整块切除率及组织学治愈性切除率高,局部复发率低,是治疗GEJ癌前病变及早癌更为安全有效的方法.
목적 장내경점막하박리술(ESD)화내경점막절제술(EMR)진행비교,평개ESD치료위식관련접부(GEJ)암전병변급조암적유효성급안전성.방법 분석28례경ESD치료화51례경EMR치료적GEJ암전병변급조암환자적림상자료,비교량충방법병조정괴절제솔、조직학치유성절제솔、수술시간、병발증、복발솔등.결과 ESD정괴절제솔위92.9％ (26/28),치유절제솔위78.6％(22/28)균우우EMR조적45.1％(23/51)화43.1％(22/51),량자차이유통계학의의(P균＜0.05).국부원위복발솔ESD조위3.6％(1/28),명현저우EMR조적19.6％( 10/51) (P ＜0.05).술후연지출혈、천공、협착등엄중병발증적발생ESD조여EMR조지간차이무통계학의의.평균수술시간ESD위(64.3±27.1)min,명현장우EMR( 27.6±14.1)min(P ＜0.05).결론 ESD화EMR상비,정괴절제솔급조직학치유성절제솔고,국부복발솔저,시치료GEJ암전병변급조암경위안전유효적방법.
Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for precancerous lesions and early cancer at gastroesophageal junction (GEJ) by comparing endoscopic mucosal resection (EMR) with ESD.Methods Data of patients with GEJ precancerous lesions or early cancer,who received EMR ( n =51 ) or ESD ( n =28) were reviewed to compared the en bloc resection rate,R0 resection rate,operation time,complication and recurrence rate between 2 methods.Results En blcc resection and R0 resection rates of ESD group (92.9％,78.6％ respectively) were significantly higher than those of EMR group (45.1％,43.1％ respectively).Local recurrence rate in ESD group (3.6％,1/28) was significantly lower than that of EMR group ( 19.6％ ).Complications including perforation,delayed hemorrhage,stricture were not significantly different between EMR and ESD groups.Mean operation time of ESD group (64.3 ±27.1 min) was significantly longer than that of EMR group (27.6 ± 14.1 min)(P ＜0.05).Conclusion ESD,with a higher cure rate and en bloc rate and a lower local recurrence rate,is superior to EMR for precancerous lesions and early cancer at GEJ.