内镜黏膜下剥离术联合小口径透明帽和弹性刀治疗食管表浅肿瘤，老年患者安全吗？
Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for superficial esophageal neoplasia. Is it safe for elderly patients?
机构信息
Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
出版信息
Surg Endosc. 2010 Sep;24(9):2110-9. doi: 10.1007/s00464-010-0907-3. Epub 2010 Feb 19.
BACKGROUND
Safety and efficacy of endoscopic submucosal dissection (ESD) for esophageal neoplasias have not been adequately investigated in elderly patients. This study was designed to evaluate the safety and efficacy of ESD for esophageal neoplasias in elderly patients.
METHODS
Fifty-three superficial esophageal neoplasias treated with ESD using a combination of small-caliber-tip transparent hood and flex knife from May 2006 to June 2009 were divided into elderly group (aged 70 years or older: 25 lesions in 23 patients) and nonelderly group (younger than aged 70 years: 28 lesions in 25 patients). Therapeutic efficacy, complications, and follow-up results were evaluated retrospectively.
RESULTS
The history of cerebral infarction or cardiopulmonary disease and the usage of antiplatelet agents or anticoagulants were significantly higher in elderly group (p 0.0050 and p 0.0013, respectively). Median procedural times in the elderly group and the nonelderly group were 93 ± 53 (range, 42-235) min and 95 ± 55 (range, 40-230) min (p 0.73), respectively. Median sizes of the neoplasias and the resected specimens were 14 ± 11 (range, 5-45) mm and 15 ± 17 (range, 5-83) mm (p 0.56), and 35 ± 12 (range, 18-60) mm and 38 ± 17 (range, 18-90) mm (p 0.38), respectively. En bloc resection rate was 100% in each group. Body temperature and white blood cell counts of the next day after ESD were significantly higher in the nonelderly group than in the elderly group (p 0.0087 and p 0.0043, respectively). There were no complications, such as postoperative bleeding or perforation, in each group. The median follow-up period of 23 ± 10 (range, 4-35) months in the elderly group revealed no local or distant metastasis.
CONCLUSIONS
ESD with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasia in elderly and nonelderly patients.
背景
内镜黏膜下剥离术（ESD）治疗食管肿瘤的安全性和有效性在老年患者中尚未得到充分研究。本研究旨在评估 ESD 治疗老年患者食管肿瘤的安全性和有效性。
方法
2006 年 5 月至 2009 年 6 月，采用小口径透明帽联合 Flex 刀对 53 例食管黏膜下肿瘤进行 ESD 治疗，将患者分为老年组（年龄≥70 岁：23 例 25 处病变）和非老年组（年龄＜70 岁：25 例 28 处病变）。回顾性分析两组患者的治疗效果、并发症及随访结果。
结果
老年组患者中脑梗死或心肺疾病病史、抗血小板药物或抗凝药物使用率明显高于非老年组（p＜0.0050 和 p＜0.0013）。老年组和非老年组的中位手术时间分别为 93±53（范围 42-235）min 和 95±55（范围 40-230）min（p=0.73），中位肿瘤大小和切除标本大小分别为 14±11（范围 5-45）mm 和 15±17（范围 5-83）mm（p=0.56）、35±12（范围 18-60）mm 和 38±17（范围 18-90）mm（p=0.38）。两组整块切除率均为 100%。ESD 术后第 1 天，老年组患者体温和白细胞计数明显高于非老年组（p=0.0087 和 p=0.0043）。两组均无术后出血或穿孔等并发症。老年组中位随访时间为 23±10（范围 4-35）个月，未见局部或远处转移。
结论
小口径透明帽联合 Flex 刀的 ESD 治疗老年和非老年患者的食管黏膜下肿瘤安全、有效。
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