Gastroenterology Department, Pomeranian Medical University, 71-242 Szczecin, Poland.
World J Gastroenterol. 2013 Mar 28;19(12):1953-61. doi: 10.3748/wjg.v19.i12.1953.
To investigate the indications, resection rate, and safety of endoscopic submucosal dissection (ESD) for neoplastic lesions in the gastrointestinal tract at a European referral center.
We carried out a retrospective analysis of the ESD procedures performed in our center for mucosal neoplastic and submucosal lesions of the gastrointestinal tract. The duration of the procedure, en bloc and complete (R0) resection rates, and complication rates were evaluated. Variables were reported as mean ± SD or simple proportions. Univariate analysis and comparisons of procedure times and resection rates were performed using Mann-Whitney U tests, or χ(2) tests for dichotomous variables.
Between 2007 and 2011, ESD was performed in a total of 103 patients (46.7% male, mean age 64.0 ± 12.7 years). The indications for the procedure were epithelial tumor (n = 54), submucosal tumor (n = 42), or other (n = 7). The total en bloc resection rate was 90.3% (93/103) and R0 resection rate 80.6% (83/103). The median speed of the procedure was 15.0 min/cm(2). The complete resection rate was lower for submucosal tumors arising from the muscle layer (68%, 15/22, P < 0.05). Resection speed was quicker for submucosal tumors localized in the submucosal layer than for lesions arising from the muscularis propria layer (8.1 min/cm(2) vs 17.9 min/cm(2), P < 0.05). The R0 resection rate and speed were better in the last 24 mo (90.1%, 49/54 and 15.3 min/cm(2)) compared to the first 3 years of treatment (73.5%, 36/49, P < 0.05 and 22.0 min/cm(2), P < 0.05). Complications occurred in 14.6% (n = 15) of patients, including perforation in 5.8% (n = 6), pneumoperitoneum in 3.9% (n = 4), delayed bleeding in 1.9% (n = 2), and other in 2.9% (n = 3). Only one patient with delayed perforation required surgical treatment. During the mean follow-up of 26 ± 15.3 mo, among patients with R0 resection, recurrence occurred in one patient (1.2%).
ESD is an effective and safe method for resection of neoplastic lesions with low recurrence. Speed and the R0 resection rate increased after 50 procedures.
探讨在一家欧洲转诊中心，内镜黏膜下剥离术（ESD）治疗胃肠道黏膜肿瘤和黏膜下肿瘤的适应证、切除率和安全性。
我们对在我院行 ESD 治疗的胃肠道黏膜肿瘤和黏膜下肿瘤患者的临床资料进行回顾性分析。评估手术时间、整块切除率和完全切除率（R0 切除率）以及并发症发生率。变量以均数±标准差或简单比例表示。采用 Mann-Whitney U 检验进行单变量分析和手术时间及切除率的比较，二分类变量采用 χ(2)检验。
2007 年至 2011 年期间，共有 103 例患者（46.7%为男性，平均年龄 64.0±12.7 岁）接受了 ESD 治疗。适应证为上皮肿瘤（n=54）、黏膜下肿瘤（n=42）或其他病变（n=7）。整块切除率为 90.3%（93/103），R0 切除率为 80.6%（83/103）。中位手术速度为 15.0 min/cm(2)。起源于黏膜肌层的黏膜下肿瘤的完全切除率较低（68%，15/22，P＜0.05）。起源于黏膜下层的黏膜下肿瘤的切除速度快于起源于固有肌层的肿瘤（8.1 min/cm(2) vs 17.9 min/cm(2)，P＜0.05）。与治疗前 3 年相比（R0 切除率为 73.5%，36/49；速度为 22.0 min/cm(2)），最近 24 个月的 R0 切除率（90.1%，49/54）和速度（15.3 min/cm(2)）更好（P＜0.05）。14.6%（15/103）的患者发生并发症，包括穿孔 5.8%（6/103）、气腹 3.9%（4/103）、延迟性出血 1.9%（2/103）和其他 2.9%（3/103）。仅 1 例延迟性穿孔患者需要手术治疗。中位随访 26±15.3 个月时，R0 切除的患者中，1 例（1.2%）复发。
ESD 是一种有效且安全的治疗方法，可用于治疗胃肠道肿瘤，其复发率低。50 例以上手术时，手术速度和 R0 切除率提高。
