本文選題：內(nèi)鏡黏膜下剝離術 + 食管早癌　； 參考：《中國人民解放軍醫(yī)學院》2016年碩士論文

【摘要】：背景與目的近10年迅速發(fā)展起來的內(nèi)鏡黏膜下剝離術(endoscopic submucosal dissection, ESD)可對大面積消化道早癌或癌前病變實現(xiàn)治愈性切除,其治療效果和價值已逐漸被臨床證實,但對于ESD治療的遠期療效,國內(nèi)報道不一,缺乏大宗病例的長期跟蹤觀察和驗證。本課題旨在研究經(jīng)ESD治療早期食管癌及癌前病變的預后及影響因素。方法收集177例(切除病灶186個)2008年1月—2013年6月因食管早癌及癌前病變在解放軍總醫(yī)院消化內(nèi)鏡中心行ESD診治患者的臨床資料,全部病灶位于胸段食管,胸部上段8個,胸部中段123個,胸部下段55個。切除病變平均最大直徑2.9 cm (1.0-6.0 cm),切除面積(2.9×2.1) cm2(1.0×0.8-6.0×5.0 cm2),手術時間平均77(20～448)min。治愈性切除153例病灶(82.26%,153/186),術中發(fā)生并發(fā)癥4例,其中出血1例、穿孔3例,經(jīng)治療均痊愈,147例都進入隨訪組；非治愈性切除25例病灶(13.44%,25/186),其中5例補充外科手術,2例行術后放療,余跟蹤隨訪；無法評估8例病灶(4.30%,8/186),全部進入隨訪組。對其預后及隨訪情況回顧性地進行分析總結。結果治愈性切除(R0)153例病灶(82.26%,153/186),術中發(fā)生并發(fā)癥4例,經(jīng)治療均痊愈,153例都進入隨訪組；非治愈性切除(R1)25例病灶(13.44%,25/186),其中5例補充外科手術,2例行術后放療,余跟蹤隨訪；無法評估(Rx)8例病灶(4.30%,8/186),全部進入隨訪組.共計隨訪166例病灶(89.25%,166/186),其中門診120例,電話隨訪46例,失訪20例,隨訪的時間范圍為1～64個月,中位隨訪的時間為39個月；隨訪6月16例,6～12月29例,12～36月71例,36月50例；術后食管狹窄11例,病變復發(fā)6例病灶(3.23%,6/166),其中2例接受外科手術,4例行再次ESD術；3～5年生存率100%。剝離食管病變環(huán)周的范圍(P=0.018)為出現(xiàn)并發(fā)癥的相關影響因素。將食管分為難于操作組(食管上段及下段)和易于操作組(食管中段),對兩組并發(fā)癥發(fā)生率、病灶大小、環(huán)周范圍、病理、手術操作時間以及患者性別、年齡等因素進行分析,差異均無顯著性.對病理進行多因素方差分析,結果為病理(OR:7.472,95% CI:2.321-68.08, p=0.021)是影響食管病變ESD術后復發(fā)的相關因素。結論ESD治療早期食管癌及癌前病變的治愈率高、發(fā)生遠期并發(fā)癥機率低、復發(fā)率低、生存率高,預后及遠期療效良好,值得在臨床上更廣泛地進行推廣。其中病理為食管病變ESD術后出現(xiàn)復發(fā)發(fā)生的相關影響因素.
[Abstract]:Background and objective the rapid development of endoscopic submucosal dissection (endoscopic submucosal dissection,) in recent 10 years can be used to cure large areas of early cancer or precancerous lesions of digestive tract. Its therapeutic effect and value have been gradually proved by clinical practice. However, there are different reports on the long-term efficacy of ESD and lack of long-term follow-up and verification of large numbers of cases. The aim of this study was to study the prognosis and influencing factors of early esophageal cancer and precancerous lesions treated by ESD. Methods from January 2008 to June 2013, 177 patients with early esophageal cancer and precancerous lesions were treated with ESD at the endoscopy center of the Chinese PLA General Hospital. All the lesions were located in the thoracic esophagus, with 8 lesions in the upper thoracic segment. There were 123 middle thoracic segments and 55 lower thoracic segments. The mean maximum diameter of lesion was 2.9 cm (1.0-6.0 cm),) cm2 (1.0 脳 0.8-6.0 脳 5.0 cm2), and the average operative time was 77 (20448) min. One hundred and fifty-three lesions (82.26 / 153 / 186) were cured and complications occurred in 4 cases, including hemorrhage in 1 case, perforation in 3 cases, and noncurable resection in 25 cases (13.444.25 / 186). 8 lesions (4.30% / 186) could not be evaluated and all of them were included in the follow-up group. The prognosis and follow-up were retrospectively analyzed and summarized. Results there were 153 cases (82.26 / 153 / 186) of cured resection (82.26 / 153 / 186), 4 cases of intraoperative complications (all cured by treatment), and 25 cases of non-curable resection (R1) (13.4444 / 25 / 186), 5 cases of which were treated with postoperative radiotherapy, and the rest were followed up. Unable to evaluate (RX) 8 lesions (4.30% / 186), all of them were included in the follow-up group. A total of 166 lesions (89.25 / 166 / 186) were followed up, of which 120 were outpatient, 46 by telephone and 20 by telephone. The follow-up time ranged from 1 to 64 months, with a median follow-up time of 39 months, followed up in 16 cases from 6 to 12 months in 71 cases from 12 to 36 months, and in 36 months in 50 cases. Postoperative esophageal stenosis occurred in 11 cases, and recurrence in 6 cases (3.23% / 166). Among them, 2 cases underwent surgery and 4 cases underwent ESD again. The survival rate of 3 ~ 5 years was 100%. The extent of circumferential dissection of esophageal lesions (P0. 018) was associated with complications. The esophagus was divided into two groups: the difficult operation group (upper and lower esophagus) and the easy-to-operate group (middle esophagus). The incidence of complications, lesion size, circumferential range, pathology, operative time, gender and age of the patients were analyzed. There was no significant difference between the two groups. The multivariate analysis of variance showed that pathology (OR: 7.47295% CI: 2.321-68.08, p0.021) was a related factor affecting the recurrence of esophageal diseases after ESD. Conclusion ESD treatment of early esophageal cancer and precancerous lesions has a high cure rate, low rate of long-term complications, low recurrence rate, high survival rate, good prognosis and long-term curative effect. It is worth popularizing more widely in clinical practice. The pathology was related to the recurrence of esophageal lesions after ESD.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R735.1
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本文編號：2085271