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目的评价内镜黏膜下剥离术(ESD)治疗胃高级别上皮内瘤变(HGIN)及早期胃癌(EGC)的长期疗效。方法回顾性分析2006年11月至2016年1月经解放军总医院消化内镜中心ESD治疗的术后病理诊断为HGIN及EGC的444例患者,对其生存状况进行随访,并结合临床病理进行总结,分析评价ESD疗效,包括:完全切除率、治愈性切除率、生存率、并发症及复发率。结果经ESD治疗的444例患者共切除病变451个,其中黏膜内癌52个(11.5%)、黏膜下癌25个(5.5%)、HGIN 374个(82.9%)。整块切除率为94.5%(426/451)、完全切除率为88.9%(401/451)、治愈性切除率为87.1%(393/451)。术中微小穿孔1例(0.2%),金属夹夹闭治愈;术后迟发性出血11例(2.3%),10例内镜下止血成功、1例内镜止血失败转外科手术治愈。术后幽门狭窄2例(0.5%),均经扩张治疗好转。444例患者中,410例患者获得随访,随访率为92.3%,随访时间平均56个月(18~109个月)。总复发率为2.9%(13/451)。随访期间死亡5例,总生存率为98.9%(439/444)。结论ESD治疗EGC具有较高的治愈率及较低的并发症发生率,长期疗效肯定。
Objective To evaluate the long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of high-grade gastric intraepithelial neoplasia (HGIN) and early gastric cancer (EGC). Methods A retrospective analysis of 444 patients with HGIN and EGC diagnosed as ESD by the digestive endoscopy center of People’s Liberation Army General Hospital from November 2006 to January 2016 was performed. Survival status was followed up and clinical and pathological findings were summarized. Analysis and evaluation of ESD efficacy, including: complete resection rate, curative resection rate, survival rate, complications and recurrence rate. Results A total of 451 lesions were resected in 444 patients with ESD, including 52 (11.5%) mucosal carcinomas, 25 (5.5%) submucosal carcinomas and 374 (82.9%) HGINs. The resection rate was 94.5% (426/451), the complete resection rate was 88.9% (401/451) and the curative resection rate was 87.1% (393/451). One case (0.2%) was punctured intraoperatively, and metal clamp was used to cure it. Postoperative delayed hemorrhage was found in 11 cases (2.3%). Ten cases were successful in endoscopic hemostasis. One case failed in endoscopic hemostasis and was surgically cured. Postoperative pyloric stenosis in 2 cases (0.5%), were treated by dilation improved. Among 444 patients, 410 patients were followed up with a follow-up rate of 92.3% and an average follow-up of 56 months (18-109 months). The overall recurrence rate was 2.9% (13/451). Five patients died during follow-up, and the overall survival rate was 98.9% (439/444). Conclusion ESD treatment of EGC has a higher cure rate and lower incidence of complications, long-term effect is sure.