内镜黏膜下隧道法剥离术治疗胃角巨大黏膜病变的多中心回顾性研究
Endoscopic submucosal tunnel dissection for treatment of large gastric angle superficial neoplasms:a multicenter retrospective study
目的 评估内镜黏膜下隧道法剥离术(ESTD)在治疗胃角巨大黏膜病变中的应用价值.方法 回顾性分析2014年7月至2016年7月在6家中心接受ESTD或内镜黏膜下剥离术(ESD)治疗的87例胃角大面积黏膜病变患者资料,其中ESTD组32例,ESD组55例.比较2组剥离时间、剥离速度、整块切除率、治愈性切除率、并发症及复发情况.结果 ESTD组剥离时间较ESD组短[(87.3±32.6)min比(136.7±64.5)min,P<0.01],剥离速度明显快于ESD组[(0.18±0.07)cm2/min比(0.08±0.05)cm2/min,P<0.01],ESTD组较ESD组整块切除率[100%(32/32)比87.3%(48/55),P=0.035]及治愈性切除率[100%(32/32)比85.5%(47/55),P=0.024]高.ESD组术中均有出血发生,有8例出现肌层损伤;而ESTD组术中出血率仅59.4%(19/32),且无肌层损伤发生(P均<0.05).2组复发率比较差异无统计学意义[0(0/32)比1.9%(1/54),P=0.443].结论 ESTD在治疗胃角巨大黏膜病变时具有更高的剥除效率,同时可有效降低手术风险,减少并发症的出现,值得临床推广.
更多Objective To evaluate the clinical value of endoscopic submucosal tunnel dissection ( ESTD) for treatment of large gastric angle superficial neoplasms. Methods A retrospective analysis was performed on data of 87 patients with superfical neoplasms in gastric angle, including 32 cases undergoing ESTD and 55 cases undergoing endoscopic submucosal dissection ( ESD) in 6 institutions between July 2014 and July 2016. The dissection time, dissection speed, en bloc resection rate, curative resection rate, adverse events, and prognosis were compared between the two groups. Results The ESTD group showed a shorter dissection time ( 87. 3 ± 32. 6 min VS 136. 7 ± 64. 5 min, P<0. 01 ) , a higher dissection speed ( 0. 18 ± 0. 07 cm2/min VS 0. 08±0. 05 cm2/min, P<0. 01), a higher en bloc resection rate[100% (32/32) VS 87. 3% (48/55), P=0. 035], and a higher curative resection rate[100% (32/32) VS 85. 5% (47/55), P=0. 024] compared with the ESD group. The intraoperative bleeding rate[59. 4% (19/32) VS 100. 0%( 55/55) , P<0. 01] and muscular injury rate[ 0 ( 0/32) VS 14. 5% ( 8/55) , P=0. 024] were lower in the ESTD group than those of the ESD group. There was no statistical difference on recurrence rate between the two groups[0 (0/32) VS 1. 9% (1/54), P=0. 443]. Conclusion ESTD has a higher dissection speed and greater security on treatment of large gastric angle superficial neoplasms, and is worthy to be generalized.
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