Nguyen-Tang Thai, Genevay Muriel, Dumonceau Jean-Marc
Service de gastro-entérologie et d'hépatologie, Département de médecine interne, HUG, I1211 Genève 14.
Rev Med Suisse. 2010 Sep 8;6(261):1642-8.
Endoscopic resection of digestive tumors: indications, quality criteria and results In the past decade, two developments have changed the approach to superficial digestive tumors: 1) new endoscopic techniques allow "en bloc" resection of superficial tumors with almost no limit in tumor diameter and 2) the risk of lymph node metastases is better stratified (e.g., in the colon, the risk of lymph node metastasis is negligible for superficial malignant invasion of the submucosa). Endoscopic submucosal dissection (ESD) allows "en bloc" resection of large laterally-spreading tumors, in contrast with prior resection techniques (endoscopic mucosal resection - EMR) that required piecemeal resection for large tumors. As a result, relapse rate is lower with ESD compared to EMR. Pathological examination is also more reliable with "en bloc" specimens; it must precisely assess resection margins and the depth of malignant invasion.
适应证、质量标准及结果 在过去十年中，有两项进展改变了浅表消化肿瘤的治疗方法：1）新的内镜技术能够“整块”切除浅表肿瘤，肿瘤直径几乎没有限制；2）淋巴结转移风险得到了更好的分层（例如，在结肠，对于黏膜下层的浅表恶性浸润，淋巴结转移风险可忽略不计）。与先前需要对大肿瘤进行分片切除的切除技术（内镜黏膜切除术 - EMR）相比，内镜黏膜下剥离术（ESD）能够“整块”切除大面积侧向扩散的肿瘤。因此，与EMR相比，ESD的复发率更低。对“整块”标本进行病理检查也更可靠；它必须精确评估切除边缘和恶性浸润深度。
