中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2013年
12期
685-689
,共5页
郭大昕%杨建民%徐启顺%楼国春%韩晓梅%潘航海
郭大昕%楊建民%徐啟順%樓國春%韓曉梅%潘航海
곽대흔%양건민%서계순%루국춘%한효매%반항해
Meta分析%食管肿瘤%内镜黏膜下剥离术%内镜下黏膜切除术
Meta分析%食管腫瘤%內鏡黏膜下剝離術%內鏡下黏膜切除術
Meta분석%식관종류%내경점막하박리술%내경하점막절제술
Meta-analysis%Esophageal neoplasms%Endoscopic submucosal dissection%Endoscopic mucosal resection
目的 探讨内镜黏膜下剥离术(ESD)和内镜下黏膜切除术(EMR)在治疗早期食管癌的有效性和安全性方面的差异.方法 检索1990年1月至2012年12月Medline、Embase、Cochrane library、万方数据库、维普数据库及中国知网数据库上发表的有关早期食管癌ESD和EMR治疗比较研究的所有中英文论文,通过纳入和排除标准筛选后最终纳入文献的效应指标采用Revman 5.1软件进行统计分析,以整块切除率、治愈性切除率、局部复发率为有效性效应指标,以穿孔、出血、狭窄和手术时间为安全性效应指标.结果 最终纳入8篇非随机对照回顾性队列研究.Meta分析显示,ESD组较EMR组整块切除率[98.36％(360/366)比41.79％(252/603),P＜0.01]、治愈性切除率[90.81％(168/185)比50.65％(194/383),P＜0.01]均显著增高,局部复发率[0.55％(2/366)比13.76％ (83/603),P＜0.01]显著降低,穿孔率[4.51％ (21/466)比1.25％ (8/640),P=0.03]明显增高,出血率[0.21％ (1/466)比0.63％ (4/640),P=0.41]和术后狭窄率[10.48％ (39/372)比10.15％(41/404),P=0.89]差异无统计学意义.结论 在早期食管癌的内镜治疗上,ESD的有效性明显优于EMR,安全性则与EMR相似,ESD应作为首选内镜治疗方法.
目的 探討內鏡黏膜下剝離術(ESD)和內鏡下黏膜切除術(EMR)在治療早期食管癌的有效性和安全性方麵的差異.方法 檢索1990年1月至2012年12月Medline、Embase、Cochrane library、萬方數據庫、維普數據庫及中國知網數據庫上髮錶的有關早期食管癌ESD和EMR治療比較研究的所有中英文論文,通過納入和排除標準篩選後最終納入文獻的效應指標採用Revman 5.1軟件進行統計分析,以整塊切除率、治愈性切除率、跼部複髮率為有效性效應指標,以穿孔、齣血、狹窄和手術時間為安全性效應指標.結果 最終納入8篇非隨機對照迴顧性隊列研究.Meta分析顯示,ESD組較EMR組整塊切除率[98.36％(360/366)比41.79％(252/603),P＜0.01]、治愈性切除率[90.81％(168/185)比50.65％(194/383),P＜0.01]均顯著增高,跼部複髮率[0.55％(2/366)比13.76％ (83/603),P＜0.01]顯著降低,穿孔率[4.51％ (21/466)比1.25％ (8/640),P=0.03]明顯增高,齣血率[0.21％ (1/466)比0.63％ (4/640),P=0.41]和術後狹窄率[10.48％ (39/372)比10.15％(41/404),P=0.89]差異無統計學意義.結論 在早期食管癌的內鏡治療上,ESD的有效性明顯優于EMR,安全性則與EMR相似,ESD應作為首選內鏡治療方法.
목적 탐토내경점막하박리술(ESD)화내경하점막절제술(EMR)재치료조기식관암적유효성화안전성방면적차이.방법 검색1990년1월지2012년12월Medline、Embase、Cochrane library、만방수거고、유보수거고급중국지망수거고상발표적유관조기식관암ESD화EMR치료비교연구적소유중영문논문,통과납입화배제표준사선후최종납입문헌적효응지표채용Revman 5.1연건진행통계분석,이정괴절제솔、치유성절제솔、국부복발솔위유효성효응지표,이천공、출혈、협착화수술시간위안전성효응지표.결과 최종납입8편비수궤대조회고성대렬연구.Meta분석현시,ESD조교EMR조정괴절제솔[98.36％(360/366)비41.79％(252/603),P＜0.01]、치유성절제솔[90.81％(168/185)비50.65％(194/383),P＜0.01]균현저증고,국부복발솔[0.55％(2/366)비13.76％ (83/603),P＜0.01]현저강저,천공솔[4.51％ (21/466)비1.25％ (8/640),P=0.03]명현증고,출혈솔[0.21％ (1/466)비0.63％ (4/640),P=0.41]화술후협착솔[10.48％ (39/372)비10.15％(41/404),P=0.89]차이무통계학의의.결론 재조기식관암적내경치료상,ESD적유효성명현우우EMR,안전성칙여EMR상사,ESD응작위수선내경치료방법.
Objective Explore the differences in effectiveness and safety between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early esophageal cancer (EEC).Methods Papers published from January 1990 to December 2012 in Medline,Embase,Cochrane library,Wanfang,VIP and CNKI were searched in English and Chinese respectively to identify the studies comparing ESD with EMR for EEC.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Revman 5.1.Outcome measures consisted of three effectiveness-relevant measures (rates of en bloc resection,curative resection,local recurrence) and four safety-relevant measures (bleeding,perforation,stenosis and operation time).Results A total of 8 non-randomized retrospective cohort studies (five full-text and three abstracts) were included.Meta-analysis showed significantly higher rates of en bloc resection [98.36％ (360/366) vs.41.79％ (252/603),P ＜ 0.01],curative resection [90.81％ (168/185) vs.50.65 ％ (194/383),P ＜ 0.01] and perforation [4.51％ (21/466) vs.1.25％ (8/640),P =0.03] in ESD group compared with EMR group,and the rate of local recurrence was significantly lower in ESD group [0.55％ (2/366) vs.13.76％ (83/603),P ＜0.01].There were no significant differences in the rates of bleeding [0.21％ (1/466) vs.0.63％(4/640),P =0.41] or stenosis [10.48％ (39/372) vs.10.15％ (41/404),P =0.89].Conclusion Compared with EMR,ESD showed obvious advantages of effectiveness and resemble risks for endoscopic resection of EEC,therefore ESD should be the first choice for endoscopic treatment of EEC.
