CAJ | 학술논문

目的比较窄带成像(NBI)与碘染色在早期食管癌内镜黏膜下剥离术(ESD)治疗中的临床价值.方法回顾性分析2010年9月至2011年8月间接受ESD治疗的87例早期食管癌(包括高级别上皮内瘤变)患者的临床资料,其中术前经NBI法确定病变边界者37例(NBI组),采用碘染色法确定病变边界者50例(碘染色组).比较两组患者ESD术中食管痉挛程度、手术时间、完整切除率、并发症发生率以及术后复发等情况.结果两组患者病变部位、大小和周径的差异均无统计学意义.NBI组中重度食管痉挛者的比例为10.8％(4/37),明显低于碘染色组的比例[32.0％(16/50),P＜0.05];手术时间亦明显短于碘染色组[(42.2±19.5) min比(53.3±30.9) min,P＜0.05].NBI组术中穿孔1例,术后迟发性出血l例;碘染色组术中穿孔1例,均经内镜下处理及保守治疗治愈.术后随访4～20月,NBI组与碘染色组患者术后食管狭窄[8.1％(3/37)比8.0％(4/50)]和局部复发[5.4％(2/37)比4.0％(2/50)]发生率的差异均无统计学意义(均P＞0.05).结论与碘染色相比,早期食管癌ESD术前采用NBI确定病变边界,可在不影响疗效的基础上减轻食管痉挛并缩短手术时间.
목적 비교착대성상(NBI)여전염색재조기식관암내경점막하박리술(ESD)치료중적림상개치.방법 회고성분석2010년9월지2011년8월간접수ESD치료적87례조기식관암(포괄고급별상피내류변)환자적림상자료,기중술전경NBI법학정병변변계자37례(NBI조),채용전염색법학정병변변계자50례(전염색조).비교량조환자ESD술중식관경련정도、수술시간、완정절제솔、병발증발생솔이급술후복발등정황.결과 량조환자병변부위、대소화주경적차이균무통계학의의.NBI조중중도식관경련자적비례위10.8％(4/37),명현저우전염색조적비례[32.0％(16/50),P＜0.05];수술시간역명현단우전염색조[(42.2±19.5) min비(53.3±30.9) min,P＜0.05].NBI조술중천공1례,술후지발성출혈l례;전염색조술중천공1례,균경내경하처리급보수치료치유.술후수방4～20월,NBI조여전염색조환자술후식관협착[8.1％(3/37)비8.0％(4/50)]화국부복발[5.4％(2/37)비4.0％(2/50)]발생솔적차이균무통계학의의(균P＞0.05).결론 여전염색상비,조기식관암ESD술전채용NBI학정병변변계,가재불영향료효적기출상감경식관경련병축단수술시간.
Objective To compare the clinical value of narrow band imaging (NBI) and iodine staining for margin determination of early esophageal cancer during endoscopic submucosal dissection (ESD).Methods Clinical data of 87 patients with early esophageal cancers undergoing endoscopic submucosal dissection(ESD) were analyzed retrospectively.Patients were assigned to NBI group and iodine staining group according to the staining method before ESD operation.Clinicopathological features,esophageal spasm ratio,operation time,en bloc resection rate,complications,local recurrence,and distant metastases were compared between the two groups.Results There were 37 patients in NBI group while 50 patients in iodine staining group.Location and size of the lesions between two groups were not significantly different.The ratio of moderate-severe esophageal spasm in NBI group was significantly lower as compared to iodine staining group [10.8％(4/37) vs.32.0％(16/50),P＜0.05].The average operation time in NBI group was significantly shorter than that in iodine staining group[(42.2±19.5) min vs.(53.3±30.9) min,P＜0.05).All the tumors were resected in an en bloc fashion and the R0 resection rate was 100％.Perforations in 2 patients and delayed bleeding in 1 patient were successfully treated by endoscopic methods.Esophageal strictures occurred in 3 patients of NBI group and 4 patients of iodine staining group,who were treated by endoscopic dilation and retrievable stents.During mean 13.2 months (range 4 to 20 months) follow-up periods,local recurrence occurred in 2 patients of NBI group and 2 patients of iodine staining group.These patients received ESD or other surgery.Conclusion Compared with iodine staining,using NBI for margin determination of early esophageal cancer during ESD is more convenient and fast because of distinctly lower degree of esophageal spasm.