中国医刊
中國醫刊
중국의간
CHINESE JOURNAL OF MEDICINE
2015年
9期
36-40
,共5页
周晓%王拥军%于中麟%李鹏%张澍田
週曉%王擁軍%于中麟%李鵬%張澍田
주효%왕옹군%우중린%리붕%장주전
早期食管癌%内镜下黏膜切除术%临床疗效%手术治疗
早期食管癌%內鏡下黏膜切除術%臨床療效%手術治療
조기식관암%내경하점막절제술%림상료효%수술치료
Early esophageal cancer%Endoscopic mucosal resection%Clinical efficacy%Surgical treatment
目的：分析内镜下黏膜切除术( endoscopic mucosal resection,EMR)对早期食管癌的治疗疗效,与外科手术效果对比,评价EMR的有效性、安全性及可行性。方法对北京友谊医院消化内镜中心2007年1月至2013年10月行EMR术或外科手术并经病理证实为早期食管癌的病例进行回顾性分析,将两组病例进行安全性及有效性对比,分析其生存率,评估EMR的可行性及安全性。结果接受内镜EMR或外科手术治疗,术后病理证实诊断为早期食管癌患者共71例。接受EMR治疗患者共47例,其中6例接受2次EMR,3例接受3次EMR,5例接受4次EMR,1例接受5次EMR治疗；接受外科手术共24例。 EMR多采用圈套器法及透明帽法,多次切除,术前黏膜下注射,抬举征阳性者切除。与外科手术组对比,EMR组操作时间、住院时间及住院花费均明显低于外科手术组。 EMR 术后并发症主要为穿孔1.28％(1/78),感染5.13％(4/78),切缘残留10.26％(8/78),食管狭窄5.13％(4/78)。首次EMR术后原位复发率为8.89％(4/45),食管癌新发率为11.11％(5/45)。 EMR术后平均生存时间为(5.47±0.14)年。 EMR组及外科手术组两组生存曲线整体Log-Rank检验结果为P=0.187,两组差异无显著性。结论早期食管癌患者应用EMR治疗安全有效,可行性高,建议在临床工作中广泛开展。
目的：分析內鏡下黏膜切除術( endoscopic mucosal resection,EMR)對早期食管癌的治療療效,與外科手術效果對比,評價EMR的有效性、安全性及可行性。方法對北京友誼醫院消化內鏡中心2007年1月至2013年10月行EMR術或外科手術併經病理證實為早期食管癌的病例進行迴顧性分析,將兩組病例進行安全性及有效性對比,分析其生存率,評估EMR的可行性及安全性。結果接受內鏡EMR或外科手術治療,術後病理證實診斷為早期食管癌患者共71例。接受EMR治療患者共47例,其中6例接受2次EMR,3例接受3次EMR,5例接受4次EMR,1例接受5次EMR治療；接受外科手術共24例。 EMR多採用圈套器法及透明帽法,多次切除,術前黏膜下註射,抬舉徵暘性者切除。與外科手術組對比,EMR組操作時間、住院時間及住院花費均明顯低于外科手術組。 EMR 術後併髮癥主要為穿孔1.28％(1/78),感染5.13％(4/78),切緣殘留10.26％(8/78),食管狹窄5.13％(4/78)。首次EMR術後原位複髮率為8.89％(4/45),食管癌新髮率為11.11％(5/45)。 EMR術後平均生存時間為(5.47±0.14)年。 EMR組及外科手術組兩組生存麯線整體Log-Rank檢驗結果為P=0.187,兩組差異無顯著性。結論早期食管癌患者應用EMR治療安全有效,可行性高,建議在臨床工作中廣汎開展。
목적：분석내경하점막절제술( endoscopic mucosal resection,EMR)대조기식관암적치료료효,여외과수술효과대비,평개EMR적유효성、안전성급가행성。방법대북경우의의원소화내경중심2007년1월지2013년10월행EMR술혹외과수술병경병리증실위조기식관암적병례진행회고성분석,장량조병례진행안전성급유효성대비,분석기생존솔,평고EMR적가행성급안전성。결과접수내경EMR혹외과수술치료,술후병리증실진단위조기식관암환자공71례。접수EMR치료환자공47례,기중6례접수2차EMR,3례접수3차EMR,5례접수4차EMR,1례접수5차EMR치료；접수외과수술공24례。 EMR다채용권투기법급투명모법,다차절제,술전점막하주사,태거정양성자절제。여외과수술조대비,EMR조조작시간、주원시간급주원화비균명현저우외과수술조。 EMR 술후병발증주요위천공1.28％(1/78),감염5.13％(4/78),절연잔류10.26％(8/78),식관협착5.13％(4/78)。수차EMR술후원위복발솔위8.89％(4/45),식관암신발솔위11.11％(5/45)。 EMR술후평균생존시간위(5.47±0.14)년。 EMR조급외과수술조량조생존곡선정체Log-Rank검험결과위P=0.187,량조차이무현저성。결론조기식관암환자응용EMR치료안전유효,가행성고,건의재림상공작중엄범개전。
Objective To analyze the effectiveness,safety and feasibility of endoscopic mucosal resection( EMR) for early esophageal cancer therapy. Method Early esophageal cancer patients confirmed by pathology treated by EMR were analyzed retrospectively in Beijing Friendship Hospital Digestive Endoscopy Center from January 2007 to Octo-ber 2013. Comparing efficacy of EMR group and surgical group,analyze their survival to assess the feasibility and safety of EMR. Result There was a total of 71 patients with early esophageal cancer accepted endoscopic EMR or surgical treatment confirmed by postoperative pathologic diagnosis in Beijing Friendship Hospital from January 2007 to October 2013. 47 patients accepted EMR therapy,six of whom received two times EMR,3 received three times EMR,5 accepted four times EMR,1 received five EMR therapies. While a total of 24 patients underwent surgery. Our hospital usually use snare or transparent cap method,repeated resection,preoperative submucosal injections,un-dergoing resection for lifting sign positive. The operating time, hospital stay and hospitalization costs of the EMR group were significantly lower than the surgical group. Post-EMR complications included perforation of 1. 28%(1/78),infection of 5. 13%(4/78),the edge residual of 10. 26%(8/78),esophageal stricture of 5. 13%(4/78), operation failure of 1. 28%(1/78). Post-first EMR recurrence rate is 8. 89%(4/45). The average survival time post-EMR was (5. 47±0. 14) years. To analyze the two sets of survival curves of the EMR group and surgical group the Log-Rank test results(P=0. 187),there was no statistically significant difference between the two groups. Conclusion EMR therapy for early esophageal cancer patients is safe and effective,feasible,which is recommended for extensive clinical practice.
