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目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌及癌前病变的安全性、有效性,为早期胃癌及癌前病变的内镜治疗提供依据。方法回顾性分析2012年10月到2014年8月在第二军医大学长海医院消化内镜中心接受ESD治疗的214例胃黏膜病变患者的临床资料,分析术前评估、病理特征、ESD治疗及术后随访等情况。结果214例患者术前评估中,接受内镜窄带成像(narrow band imaging,NBI)检查者67例(31.3%),NBI联合放大内镜(magnifying endoscopy,ME)检查者39例(18.2%),超声内镜(endoscopic ultrasonography,EUS)检查者50例(23.4%),CT检查者50例(23.4%),活组织检查者192例(89.7%)。214例病灶术后病理中,低级别上皮内瘤变84例(39.2%)、高级别上皮内瘤变55例(25.7%)、高分化癌45例(21.0%)、中分化癌19例(8.9%)、低分化癌11例(5.1%)。ESD整块切除率为96.3%,完整切除率为92.1%;ESD手术时间为14~290min,平均(59.9±49.6)min;术中大出血2例(0.9%),术中穿孔2例(0.9%);术后延迟出血5例(2.3%),术后复发5例(2.3%),无患者发生术后延迟性穿孔。结论 ESD是治疗早期胃癌及癌前病变的有效手段,但应进行完善的术前评估以避免不必要或过度的ESD治疗,术后定期随访是监测术后病灶残留与复发的有效手段。
Objective To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer and precancerous lesions and provide the basis for endoscopic treatment of early gastric cancer and precancerous lesions. Methods The clinical data of 214 patients with gastric mucosal lesions undergoing digestive endoscopy at the Digestive Endoscopy Center of Changhai Hospital, Second Military Medical University from October 2012 to August 2014 were analyzed retrospectively. Preoperative evaluation, pathological features, ESD treatment and operation Follow-up and so on. Results In preoperative evaluation of 214 patients, 67 (31.3%) were underwent narrow band imaging (NBI), 39 (18.2%) were examined by NBI combined with magnifying endoscopy (ME) There were 50 cases (23.4%) with endoscopic ultrasonography (EUS), 50 cases (23.4%) with CT and 192 cases (89.7%) with biopsy. Among the 214 cases, 84 cases (39.2%) were classified as low grade intraepithelial neoplasia, 55 cases (25.7%) with high grade intraepithelial neoplasia, 45 cases (21.0%) with well differentiated carcinoma and 19 cases with moderately differentiated carcinoma 8.9%), poorly differentiated carcinoma in 11 cases (5.1%). The total removal rate of ESD was 96.3% and the complete resection rate was 92.1%. The ESD operation time ranged from 14 to 290 minutes (mean, 59.9 ± 49.6) minutes. Two cases (0.9% ); Postoperative delayed bleeding in 5 cases (2.3%), postoperative recurrence in 5 cases (2.3%), no postoperative delayed perforation. Conclusion ESD is an effective method for the treatment of early gastric cancer and precancerous lesions. However, perfect preoperative evaluation should be performed to avoid unnecessary or excessive ESD treatment. Postoperative follow-up is an effective measure to monitor the residual and recurrence of postoperative lesions.