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内镜下黏膜剥离术治疗早期胃癌42例
作者:万艳  张锦  白艳霞  刘欢  袁贝贝  戴光荣 
单位:延安大学附属医院消化内科  陕西 延安 716000 
关键词:胃肿瘤/病理学 胃肿瘤/外科学 胃镜检查 胃肿瘤/超声检查 回顾性研究 
DOI:R735.2;R730.23
出版年,卷(期):页码:2018,33(3):266-270
摘要:

目的 探讨超声内镜联合放大内镜结合窄带成像(magnifying endoscopy with narrow-band imaging,ME-NBI)在早期胃癌诊断中的临床价值及经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌的临床疗效。方法 回顾性分析经ESD术治疗的42例早期胃癌患者胃镜下表现和病理检查结果情况。结果 42例患者均成功接受ESD术,手术时间20~120 min,(54.89±27.05) min。整块切除率为100%,癌变组织完整切除率为92.9%(39/42),治愈性切除率78.5%(33/42)。随访36个月,生存率为92.9%(39/42)。术后出血占2.4%(1/42,胃窦),溃疡占16.7%(7/42),溃疡出血占4.8%(2/42)。超声下病变深度与术后病理检查结果比较一致性较好,Kappa值为0.867(P<0.01)。ME-NBI观察血管情况与术后组织病理检查结果比较,差异无统计学意义(P=0.473),但观察腺管结构差异具有统计学意义(P=0.015)。ME-NBI联合超声内镜检测侵犯深度与术后病理侵犯深度的一致性较高,Kappa值为0.879(P<0.01)。结论 ME-NBI联合超声内镜探测病变浸润深度与病理检测一致性比单独使用超声内镜高,对提高早期胃癌的诊断率有很大帮助。在治疗上,ESD术安全性及可靠性均较高。

Objective To investigate the clinical value of endoscopic ultrasonography combined with magnifying endoscopy with narrow-band imaging (ME-NBI) in the diagnosis of early gastric cancer, as well as the clinical curative effect of endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer.Methods The clinical manifestation under gastroscope and the pathological results of 42 early gastric cancer patients after ESD treatment were retrospectively analyzed.Results Forty-two cases were successfully treated with ESD. The operation time ranges between 20 to 120 (54.89±27.05) min, with a block resection rate of 100%. The complete resection rate of cancerous tissue was 92.9% (39/42), and the curative resection rate was 78.5% (33/42). All patients were followed up regularly for 36 months, and the survival rate was 92.9% (39/42). After the surgery, the rate of postoperative bleeding was 2.4% (1/42, gastric antrum), the rate of ulcer was 16.7% (7/42), and the rate of ulcer bleeding was 4.8% (2/42). In the determination of lesion depth, endoscopic ultrasonography displayed good consistency with postoperative pathological test, with a kappa value of 0.867 (P<0.01). Similarly, regarding to the examination of vascular condition, ME-NBI has no statistically significant difference compared with postoperative histopathology (P=0.473). However, the results of gland structure were statistically significant between the two methods (P=0.015). Finally, there was a high consistency between ME-NBI combined with endoscopic ultrasonography and postoperative pathological tests in the analyses of invasion depth, and the kappa value was 0.879(P<0.01).Conclusion ME-NBI combined with endoscopic ultrasonography had higher consistency than using endoscopic ultrasonography when comparing with pathological examination in detecting invasion depth. ME-NBI combined with endoscopic ultrasonography can significantly improve the diagnosis rates of early gastric cancer, and ESD has satisfactory safety and reliability in the treatment of early gastric cancer.

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