南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2014年
1期
36-40
,共5页
翟亚奇%令狐恩强%李惠凯%秦治初%冯秀雪%王向东%杜红%孟江云%王红斌%朱静
翟亞奇%令狐恩彊%李惠凱%秦治初%馮秀雪%王嚮東%杜紅%孟江雲%王紅斌%硃靜
적아기%령호은강%리혜개%진치초%풍수설%왕향동%두홍%맹강운%왕홍빈%주정
食管浅表性肿瘤%内镜下隧道式黏膜剥离术%内镜下黏膜剥离术
食管淺錶性腫瘤%內鏡下隧道式黏膜剝離術%內鏡下黏膜剝離術
식관천표성종류%내경하수도식점막박리술%내경하점막박리술
esophageal superficial neoplasms%endoscopic submucosal tunnel dissection%endoscopic submucosal dissection
目的:比较隧道式黏膜剥离术(ESTD)与常规黏膜剥离术(ESD)治疗食管大面积浅表性肿瘤手术效率和安全性。方法回顾性分析2010年10月~2013年6月于我院消化内镜中心行食管肿瘤内镜下切除治疗235例患者的临床资料。按照纳入和排除标准,筛选接受ESTD或ESD治疗的食管大面积浅表性肿瘤患者,分析其临床资料。结果共29例患者纳入研究,平均年龄62岁(49~78岁),男16例,女13例,手术平均时间81.3 min(34~239 min)。其中ESTD组11例,ESD组18例。两组比较,ESTD组剥离速度明显快于ESD组(22.4±5.2 mm2/min vs 12.2±4.0 mm2/min,P<0.05)。虽然两组整块切除率差异不明显[100%(11/11) vs 83.3%(15/18),P>0.05],但在根治性切除率方面,ESTD明显高于ESD组[81.8%(9/11)vs 66.7%(12/18),P<0.05]。ESD组有1例出现术中出血,而ESTD组均无出血、穿孔及纵膈气肿发生。术后8例发生食管狭窄,其发生率同病变环周程度和长度有关(P<0.05)。结论ESTD不仅能安全有效地完成食管大面积的表浅性肿瘤的切除,而且同ESD相比,手术时间短,剥离速度快,肿瘤根治性切除率高。但是,对于食管环周超过3/4或长度超过50 mm的病变,应注意防治术后食管狭窄的发生。
目的:比較隧道式黏膜剝離術(ESTD)與常規黏膜剝離術(ESD)治療食管大麵積淺錶性腫瘤手術效率和安全性。方法迴顧性分析2010年10月~2013年6月于我院消化內鏡中心行食管腫瘤內鏡下切除治療235例患者的臨床資料。按照納入和排除標準,篩選接受ESTD或ESD治療的食管大麵積淺錶性腫瘤患者,分析其臨床資料。結果共29例患者納入研究,平均年齡62歲(49~78歲),男16例,女13例,手術平均時間81.3 min(34~239 min)。其中ESTD組11例,ESD組18例。兩組比較,ESTD組剝離速度明顯快于ESD組(22.4±5.2 mm2/min vs 12.2±4.0 mm2/min,P<0.05)。雖然兩組整塊切除率差異不明顯[100%(11/11) vs 83.3%(15/18),P>0.05],但在根治性切除率方麵,ESTD明顯高于ESD組[81.8%(9/11)vs 66.7%(12/18),P<0.05]。ESD組有1例齣現術中齣血,而ESTD組均無齣血、穿孔及縱膈氣腫髮生。術後8例髮生食管狹窄,其髮生率同病變環週程度和長度有關(P<0.05)。結論ESTD不僅能安全有效地完成食管大麵積的錶淺性腫瘤的切除,而且同ESD相比,手術時間短,剝離速度快,腫瘤根治性切除率高。但是,對于食管環週超過3/4或長度超過50 mm的病變,應註意防治術後食管狹窄的髮生。
목적:비교수도식점막박리술(ESTD)여상규점막박리술(ESD)치료식관대면적천표성종류수술효솔화안전성。방법회고성분석2010년10월~2013년6월우아원소화내경중심행식관종류내경하절제치료235례환자적림상자료。안조납입화배제표준,사선접수ESTD혹ESD치료적식관대면적천표성종류환자,분석기림상자료。결과공29례환자납입연구,평균년령62세(49~78세),남16례,녀13례,수술평균시간81.3 min(34~239 min)。기중ESTD조11례,ESD조18례。량조비교,ESTD조박리속도명현쾌우ESD조(22.4±5.2 mm2/min vs 12.2±4.0 mm2/min,P<0.05)。수연량조정괴절제솔차이불명현[100%(11/11) vs 83.3%(15/18),P>0.05],단재근치성절제솔방면,ESTD명현고우ESD조[81.8%(9/11)vs 66.7%(12/18),P<0.05]。ESD조유1례출현술중출혈,이ESTD조균무출혈、천공급종격기종발생。술후8례발생식관협착,기발생솔동병변배주정도화장도유관(P<0.05)。결론ESTD불부능안전유효지완성식관대면적적표천성종류적절제,이차동ESD상비,수술시간단,박리속도쾌,종류근치성절제솔고。단시,대우식관배주초과3/4혹장도초과50 mm적병변,응주의방치술후식관협착적발생。
Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.