摘要
目的探讨窄带成像放大内镜(NBI-ME)联合内镜黏膜下剥离术(ESD)在浅表型(0~Ⅱ型)早期胃癌(EGC)诊治中的临床应用价值。方法前瞻性选取2015年8月至2019年7月安庆市第一人民医院ESD治疗的64例0~Ⅱ型胃分化型黏膜内癌或胃黏膜高级别上皮内瘤变患者为研究对象。随机将其分为靛胭脂染色标记病灶边界的对照组和NBI-ME标记病灶边界的观察组。比较两组患者的手术一般情况、手术疗效及手术并发症。结果观察组手术时间、术后病理标本直径和病理标本面积在胃上部、胃下部及总和病例组中明显低于对照组(P<0.05)。观察组水平切缘阳性率0%(0/32)稍低于对照组6.25%(2/32);观察组整块切除率100%(32/32)、完全切除率96.9%(31/32)和治愈性切除率93.8%(30/32)分别略高于对照组93.8%(31/32)、93.8%(30/32)和90.6%(29/32),差异无统计学意义(P>0.05)。观察组并发症6.25%(2/32)明显低于对照组25.0%(8/32),差异有统计学意义(P<0.05)。结论采用NBI-ME联合ESD治疗0~Ⅱ型EGC可能准确判断病灶边界,显著减少病灶切除范围,缩短手术时间,降低并发症发生率,具有较高的整块切除率、完整切除率和治愈性切除率。
Objective To investigate the clinical value of narrow-band imaging magnifying endoscopy(NBI-ME)combined with endoscopic submucosal dissection(ESD)in the diagnosis and treatment for nonprotruding and nonexcavated(type 0~Ⅱ)early gastric cancer(EGC).Methods A series of 64 patients with type 0~Ⅱ intramucosal differentiated early gastric cancers or gastric mucosal high-grade intraepithelial neoplasias treated by ESD in Anqing First People's Hospital from August 2015 to July 2019 were enrolled in the study.All patients were divided into control group and observation group according to the location of the lesions.In control group,the margins of each lesion were examined by chromoendoscopy with indigo carmine,while in observation group,the margins of each lesion were examined by NBI-ME.The general conditions,surgical outcomes and surgical complications of the two groups were compared.Results The operation time,the diameter and the area of the pathological specimens in the upper part,the lower part and total lesions of stomach in the observation group were significantly lower than those in the control group;The positive rate of horizontal cutting edge in the observation group was 0%(0/32)lower than 6.25%(2/32)in the control group;the rate of en bloc resection,R0 resection and curative resection in the observation group were 100%(32/32),96.9%(31/32)and 93.8%(30/32)higher than 93.8%(31/32),93.8%(30/32)and 90.6%(29/32)in the control group,respectively,with no significant difference(P>0.05).The complications in the observation group were 6.25%(2/32)significantly lower than those in the control group(8/32),the difference was statistically significant(P<0.05).Conclusion The use of NBI-ME combined with ESD in the treatment of type 0~Ⅱ EGC may accurately determine the boundary of the lesion,significantly reduce the scope of lesion resection,shorten the operation time,reduce complications,and have a high rate of complete resection,complete resection and curative resection.It has a good application prospect.
作者
曹富流
凌安生
朱芳来
CAO Fu-liu;LING An-sheng;ZHU Fang-lai(Department of Gastroenterology,Anqing First People's Hospital,Anqing Anhui 246003,China)
出处
《临床和实验医学杂志》
2020年第19期2078-2081,共4页
Journal of Clinical and Experimental Medicine
基金
安徽省卫生厅医学科研课题计划项目(编号:09C144ESD)。
关键词
早期胃癌
窄带成像放大内镜
内镜黏膜下剥离术
浅表型
Early gastric cancer
NBI-ME
Endoscopic submucosal dissection
Nonprotruding and nonexcavated
