中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (08): 656-659.

• 专题笔谈 • 上一篇    下一篇

早期胃癌行内镜黏膜下剥离术指征及评价

姚礼庆，钟芸诗，时    强   

  1. 复旦大学附属中山医院内镜中心  复旦大学内镜诊疗研究所,上海200032
  • 出版日期:2011-08-01 发布日期:2011-08-01

  • Online:2011-08-01 Published:2011-08-01

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摘要：

内镜黏膜下剥离术（ESD）是一种内镜下整块切除病变黏膜的治疗方法，已经成为早期胃癌的治疗选择之一。目前ESD治疗早期胃癌较为积极的指征为：（1）分化型黏膜内癌如果表面未形成溃疡，则病变大小不受限制；（2）分化型黏膜内癌如果表面已经形成溃疡，则病变直径≤30mm；（3）分化型sm1癌，病变直径≤30mm；（4）未分化型黏膜内癌，表面未形成溃疡，且病变直径≤20mm。尽管长期随访的资料较少，但目前看来，如果合理地把握ESD治疗指征，早期胃癌的治愈率与手术相当，但可减少并发症，提高病人生活质量，具有安全、可行、有效的特点。

关键词: 早期胃癌, 内镜黏膜下剥离术, 手术指征

Abstract:

Indication and evaluation of endoscopic submucosa dissection in the treatment of early gastric cancer       YAO Li-qing, ZHONG Yun-shi, SHI Qiang. Endoscopy Center，Zhongshan Hospital，Fudan University；Endoscopy Research Institute，Fudan University, Shanghai 200032, China
Abstract    Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions, permitting removal of early gastric cancer (EGC) en bloc. The extended criterias of the ESD operation on EGC include that (1) differentiated mucosal cancers without ulceration irrespective of tumor size; (2) differentiated mucosal cancers irrespective of ulcer less than 30mm; (3)differentiated sm1 carcinoma, lesion diameter less than 30mm; (4)undifferentiated mucosal cancers without ulceration less than 20mm. If ESD is performed for patients with EGC that fulfilled the suitable criteria, the prognosis is similar to the traditional open surgery. Complications may be reduced and the quality of patients’ life can be improved significantly. ESD is an effective and safe therapy in the management of EGC.

Key words: early gastric cancer, endoscopic submucosal dissection, surgical indication