CAJ | 학술논문

背景与目的：食管内镜治疗近年来发展迅速，本研究旨在探讨新型多环黏膜切除器DT-6在食管内镜下切除术(endoscopic resection，ER)的应用价值。方法：2011年6月至今，复旦大学附属肿瘤医院胸外科使用DT-6多环黏膜切除器完成了100例食管内镜下切除术。选取已有6个月以上随访期的患者为研究对象，对手术参数、围手术和术后随访情况作总结和分析，并比较食管切除术和内镜治疗在治疗食管癌前病变或早期癌的围手术参数。结果：2011年6月-2012年1月，共有32例患者在复旦大学附属肿瘤医院胸外科接受食管内镜下切除术，术中均使用新型DT-6。32例患者中，男性22例，女性10例，平均年龄59.0岁(25~83岁)。共进行了34次内镜下切除术，包括31例内镜下黏膜切除(endoscopic mucosal resection，EMR)和3例内镜黏膜下病变剥离术(endoscopic submucosal dissection，ESD)，平均每次手术切取标本数为(3.4±1.0)块，标本平均直径为(11.8±2.7)mm，术中出血量为(5.45±1.47)mL。术后中位随访时间8.3个月，无一例出现出血、穿孔或食管狭窄。食管癌前病变和早期癌行食管内镜下切除术相比食管切除术在手术用时、出血量、住院时间和并发症方面差异均有统计学意义(P＜0.05)。结论：新型多环黏膜切除器行食管内镜下切除术具有简便、安全、有效的优势，值得进一步推广。内镜手术与食管切除术对早期食管癌(T1a之前)和高级别上皮内瘤变的远期治疗效果是否等同，还需要经过长期的临床随访。
배경여목적：식관내경치료근년래발전신속，본연구지재탐토신형다배점막절제기DT-6재식관내경하절제술(endoscopic resection，ER)적응용개치。방법：2011년6월지금，복단대학부속종류의원흉외과사용DT-6다배점막절제기완성료100례식관내경하절제술。선취이유6개월이상수방기적환자위연구대상，대수술삼수、위수술화술후수방정황작총결화분석，병비교식관절제술화내경치료재치료식관암전병변혹조기암적위수술삼수。결과：2011년6월-2012년1월，공유32례환자재복단대학부속종류의원흉외과접수식관내경하절제술，술중균사용신형DT-6。32례환자중，남성22례，녀성10례，평균년령59.0세(25~83세)。공진행료34차내경하절제술，포괄31례내경하점막절제(endoscopic mucosal resection，EMR)화3례내경점막하병변박리술(endoscopic submucosal dissection，ESD)，평균매차수술절취표본수위(3.4±1.0)괴，표본평균직경위(11.8±2.7)mm，술중출혈량위(5.45±1.47)mL。술후중위수방시간8.3개월，무일례출현출혈、천공혹식관협착。식관암전병변화조기암행식관내경하절제술상비식관절제술재수술용시、출혈량、주원시간화병발증방면차이균유통계학의의(P＜0.05)。결론：신형다배점막절제기행식관내경하절제술구유간편、안전、유효적우세，치득진일보추엄。내경수술여식관절제술대조기식관암(T1a지전)화고급별상피내류변적원기치료효과시부등동，환수요경과장기적림상수방。
Background and purpose:Endoscopic treatment is a promising therapeutic option for superifcial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection (ER) using the new Duette multiband mucosectomy kit (DT-6) on treating esophageal disease. Methods:Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia (HGD) lesions and early esophageal cancer. Results:From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 (22 male and 10 female, mean age 59.0 years, range 25 to 83 years). There were (3.4±1.0) specimen resected per operation, and the average greatest diameter was (11.8±2.7)mm. Intraoperative blood loss was (5.45±1.47)mL. The median follow-up period was 8.2 months with a 100%half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection (ESD), no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion:ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.