摘要
目的消化道早期癌内镜诊疗逐渐受到重视,对消化道癌前病变及早期癌的治疗产生了深远影响。找寻安全有效的治疗方式是目前临床对早期癌及癌前病变患者的研究热点。本研究总结近年来本中心内镜下治疗的500例癌前病变及早期癌病例资料,评估内镜治疗上消化道黏膜病变的有效性和安全性。方法回顾性分析2011-07-01-2018-12-31磁县人民医院28例采用氩离子凝固术(argon plasma coagulation,APC)、22例采用多环套扎黏膜切除术(multi-band mucosectomy,MBM)、350例采用黏膜切除术(endoscopic mucosalresection,EMR)和100例采用黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的上消化道黏膜病变患者的临床资料,并对比分析4种方法在病灶大小、手术时间、并发症、随访结果及成本效益方面的差异。结果ESD组直径大小为(8.0±5.0)cm、MBM和EMR组为(5.0±2.0)cm,APC组为(3.0±1.5)cm;ESD组手术时间为(120±20)min,MBM和EMR组为(30±15)min,APC组为(20±10)min;ESD组病灶完全消除率为99.00%(99/100),MBM组为95.45%(21/22),EMR组为94.29%(330/350);ESD组术后出血及穿孔并发症发生率为5.00%(5/100),EMR组为0.57%(2/350),P=0.002;MBM组和APC组未出现出血及穿孔等并发症;术后随访复查ESD组和MBM组未见局部复发,EMR组局部复发率为4.29%(15/350),APC组复发率为10.71%(3/28),P=0.124;ESD组手术成本为6500元/例,MBM组为3800元/例,EMR组为3850元/例,APC组为650元/例。结论对于直径≤3.0cm而内镜下评估位于黏膜层的病灶,应用MBM、EMR和APC的方法均可以有效消除病灶,并缩短手术时间,降低医疗费用。而对于直径>3.0cm和经过内镜评估病变较深或多次活检后内镜下注射抬举不良的病灶,宜采取ESD的手术方式。
OBJECTIVE The endoscopic diagnosis and treatment of early digestive tract cancer has gradually received attention,which has a profound impact on the treatment of precancerous lesions and early cancer of the digestive tract.Finding safe and effective treatment is the focus of clinical research on patients with early and precancerous lesions.This study summarized the data of 500 cases of precancerous lesions and early cancer treated by endoscopic treatment in our center in recent years,and evaluated the effectiveness and safety of endoscopic treatment of upper gastrointestinal mucosal lesions.METHODS Clinical data of 28 cases using argon plasma coagulation(APC),22 cases using multi-band mucosectomy(MBM),350 cases using endoscopic mucosal resection(EMR)and 100 cases using endoscopic submucosal dissection(ESD)were retrospectively analyzed.All the cases were with upper gastrointestinal mucosal lesions.The differences between the four methods in lesion size,operation time,complications,follow-up results and cost-effectiveness were compared.RESULTS The diameter of the ESD group was(8.0±5.0)cm,the MBM and EMR groups was(5.0±2.0)cm,and the APC group was(3.0±1.5)cm.The operation time of the ESD group was(120±20)min,MBM and EMR was(30±15)min in the group,and APC group was(20±10)min.The complete elimination rate of lesions in the ESD group was 99.00%(99/100),the MBM group was 95.45%(21/22),and the EMR group was 94.29%(330/350).The incidence of postoperative hemorrhage and perforation complications in the ESD group was 5.00%(5/100)and in the EMR group was 0.57%(2/350).No complications such as bleeding and perforation occurred in the MBM and APC groups.There was no local recurrence in the ESD group and MBM group during follow-up.The local recurrence rate in the EMR group was 4.29%(15/350),and in the APC group was 10.71%(3/28)(P=0.124).The operation cost of ESD group was RMB 6500/case,MBM group was RMB 3800/case,EMR group was RMB 3850/case,and APC group was RMB650/case.CONCLUSIONS For lesions with a diameter of less than 3.0 cm that are located endoscopically in the mucosal layer,the methods of MBM,EMR,and APC can effectively eliminate the lesions,shorten the operation time,and reduce medical costs.For those with a diameter more than 3.0 cm and deep lesions after endoscopic assessment or multiple endoscopic biopsy injections with poor lifting,the use of ESD surgery can achieve satisfactory results.
作者
陈继理
李爱芳
陈思远
王伟鹏
杨文清
李学民
张立玮
CHEN Ji-li;LI Ai-fang;CHEN Si-yuan;WANG Wei-peng;YANG Wen-qing;LI Xue-min;ZHANG Li-wei(Cixian People's Hospital,Cixian056500,P.R.China;Fourth Hospital of Hebei Medical University,Office of Cancer Early Diagnosis and Treatment Project ofHebei Province,Shijiazhuang050011,P.R.China)
出处
《社区医学杂志》
2019年第24期1540-1543,共4页
Journal Of Community Medicine
基金
国家重点研发计划(2016YFC1302800,2016YFC0901400).
作者简介
第一作者:陈继理,男,河北磁县人,主任医师,主要从事消化道疾病内镜下诊断及治疗的临床研究工作。Tel:86-310-2358258 E-mail:740845525@qq.com;通讯作者:张立玮,女,河北石家庄人,硕士,主任医师,主要从事消化道早癌内镜诊断及治疗的临床研究工作。E-mail:hbsyzlw@126.com
