CAJ | 학술논문

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.
목적 진일보탐토내경하행EMR(Endoscopic mucosal resection,내경점막절제술)화ESD(Endoscopic submucosal dissection,내경점막박리술)치료소화도조기종류적림상료효화안전성.방법 장2009년이래아원수치적경내경화병리조직학명학진단위중도불전형증생、암전병변화원위암적소화도조기종류적병례분위량조,분별진행EMR화ESD치료.비교량조수술시간화병발증발생솔；치료2주후,내경복사,관찰치료효과.결과 행EMR화ESD적병례(각30례)균순리완성,소유병례균완정회수표본진행조직병이학검측,량조균미출현천공；EMR조발생출혈2례,출혈솔6.67％( 2/30)；ESD조발생17례출혈,출혈솔56.67％( 17/30)；량조출혈솔비교,차이유통계학의의(x2=17.33,P＜0.05).림상료효관찰:EMR조7례유병조잔류,잔류솔23.33％ (7/30); ESD조2례유병조잔류,잔류솔6.67％( 2/30)；량조병조잔류솔비교,차이유통계학의의(x2=3.91,P＜0.05).결론 EMR조작상대간단、수술시간교단、용역피장악、출혈천공솔교저；이ESD조작기술비교복잡,요구숙련정도고,수술시간교장,용역발생출혈급천공.대우소화도조기종류,재내경하행EMR화ESD취가체도근치목적,기가보증병변완전절제,우능제고환자생존질량,병가체도외과수술상사적효과.
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.