| 吴义先,张焰平,李敏,等.内镜黏膜下剥离术治疗老年早期上消化道肿瘤的效果[J].中国临床保健杂志,2021,24(1):133-136. |
| 内镜黏膜下剥离术治疗老年早期上消化道肿瘤的效果 |
| Clinical observation of endoscopic submucosal dissection ESD in the treatment of early upper digestive tract tumors in the elderly patients |
| 投稿时间：2020-09-02 |
| DOI：10.3969/J.issn.1672-6790.2021.01.034 |
| 中文关键词: 胃肿瘤 内窥镜黏膜切除术 早期医疗干预 老年人 |
| 英文关键词: Stomach neoplasms Endoscopic mucosal resection Early medical intervention Aged |
| 基金项目:安徽省安庆市科技计划项目(2018Z2001) |
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| 中文摘要: |
| 目的 探讨内镜黏膜下剥离术治疗老年上消化道早期肿瘤的疗效。方法 收集安徽医科大学附属安庆医院消化内科2017年3月至2019年10月收治的67例老年上消化道早期肿瘤患者的临床资料,患者入院后均行内镜黏膜下剥离术(ESD),术后跟踪随访,评估内镜治疗的术前术后病理结果、并发症发生率、病灶整块切除率、住院时间、术后残留及复发发生率和随访情况。结果 67例患者共切除病变70个,食管27例,贲门11例,胃体6例,胃窦体交界3例,胃窦13例,胃角7例,其中1例患者同时切除2处病变,1例患者同时切除3个病变;70个病灶均为浅表型(Ⅱ),隆起型30个,平坦型29个,凹陷型11个,术后病理为低级别上皮内瘤变(LGIN)19个,高级别上皮内瘤变(HGIN)27个,黏膜内癌(MC)18个,黏膜下癌(SMC)6个。全部病灶均一次性整块切除,整块切除率为100%,全部病例水平切缘均阴性,2例垂直切缘阳性,完全切除率为97.1%(68/70)；2例术后病理可见脉管内癌栓,治愈性切除率为94.3%(66/70)。术后未见迟发性出血及穿孔,出现食管狭窄2例,术后并发症总发生率为3.0%(2/67)。术后内镜随访6~24个月,无病变残留及复发情况。结论 内镜黏膜下剥离术治疗老年上消化道早期肿瘤疗效确切,且术后并发症发生率低。 |
| 英文摘要: |
| Objective To evaluate the therapeutic effect of endoscopic submucosal dissection in the treatment of early upper digestive tract tumors in the elderly patients.Methods The clinical data of 67 elderly patients with early upper digestive tract tumors treated in the Department of Gastroenterology of Anqing Hospital affiliated to Anhui Medical University from March 2017 to October 2019 were collected.All the patients were treated with endoscopic submucosal dissection(ESD).Postoperative follow-up was performed to evaluate the preoperative and postoperative pathological results,incidence of complications,mass resection rate,hospital stay,postoperative residual and recurrence rate and follow-up frequency.Results Total of 70 lesions were resected in 67 patients,including esophagus in 27 cases,cardia in 11 cases,gastric body in 6 cases,antrum junction in 3 cases,antrum in 13 cases and gastric angle in 7 cases and one patient resected 2 lesions at the same time,one patient resected 3 lesions at the same time.All 70 lesions were superficial phenotypic (II) with 30 protuberant type,29 flat type,and 11 sunken type.Postoperative pathology showed low-grade intraepithelial neoplasia (LGIN) in 19 cases,high-grade intraepithelial neoplasia (HGIN) in 27 cases,mucosal intraepithelial carcinoma (MC) in 18 cases and 6 submucosal carcinomas (SMC).All the lesions were resected at one time with the resection rate of 100%.The horizontal margin was negative in all cases while the vertical margin was positive in 2 cases with the complete resection rate was 97.1%(68/70).Besides,intravascular tumor thrombus was found in 2 cases after operation so the curative resection rate was 94.3% (66/70).There were no patients with delayed bleeding and perforation after operation,and esophageal stricture occurred in 2 cases.The total incidence of postoperative complications was 3.0% (2/67).There was no residual lesion and recurrence after endoscopic follow-up for 6-24 months.Conclusion Endoscopic submucosal dissection is effective in the treatment of early upper digestive tract tumors in the elderly patients with low incidence of postoperative complications. |
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