早期胃癌（EGC）内镜下粘膜切除术(EMR)的远期临床后果的影响因素

hxq2007

Factors affecting long-term clinical outcomes of endoscopic mucosal resection of early gastric cancer.
Youn JC, Youn YH, Kim TI, Park SW, Lee SJ, Song SY, Chung JB, Lee YC, Youn JC, Youn YH.
Department of Internal Medicine, Institute of Gastroenterology, Brain Korea 21 Project for Medical Science Yonsei University College of Medicine, Seoul, Korea.
BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been widely accepted as a treatment option for early gastric cancer (EGC) in selected cases. The purposes of this study were to evaluate the long-term outcomes and the factors affecting the clinical outcomes, of EMR performed in EGC. METHODOLOGY: Between April 1996 and March 2005, 147 patients have undergone EMR to treat EGC at Yonsei University Medical Center, Seoul, Korea. We assessed the clinical outcomes of the EMR for EGC in a long-term follow-up period. We also reviewed the medical records of the patients including demographic data, endoscopic characteristics of the lesion and histopathologic findings. RESULTS: The histopathologic evaluations after the EMR treatment showed that overall complete resection rate was 84.6% (126/149) while complete resec tion rate of 93.5% was achieved in mucosal cancers (115/123). The success of complete resection was significantly affected by endoscopic gross type (depressed lesion), the degree of differentiation, and the depth of invasion, independently. There were only 5 cases of local recurrence during the follow-up periods, and the recurred or incompletely resected lesions were successfully treated by salvage operation or endoscopic retreatment. There was no disease-related or treatment-related mortality during the follow-up period. CONCLUSIONS: EMR is a good and safe curative treatment option with feasible clinical outcomes in patients with EGC. It must be emphasized that a proper selection of candidates is mandatory to improve the clinical outcome of EMR in EGC.
PMID: 16995480 [PubMed - indexed for MEDLINE]
内镜下黏膜切除术（EMR）对于早期胃癌病例的治疗这一观点已得到了广泛的认可。这篇论文的目的在于评估这种技术的长期成果和其在临床实际应用中的影响因素。 方法：从1996年4月到2005年3月这段时间里，在韩国汉城的Yonsei大学医药研究所已经有147位早期胃癌的病人接受了内窥镜黏膜切除术的治疗。 我们以长期随访的方式对内窥镜黏膜切除术在早期胃癌上的临床实际应用结果进行了评估。我们也回顾了病人的病例档案其中包括统计学数据的分析，病变的镜下改变和组织病理学的发现。 结果：在对内窥镜黏膜切除术治疗后的组织病理学评估显示当黏膜早期癌使用完全切除术达到93.5％时后的患者使完全切除术有效率达到了84.6％。这个完全切除术的成功明显分别受内窥镜下大体类型（如凹陷性病变），分化程度以及侵润程度的影响。 在随访期间仅有5个 局部复发的病例出现，并且通过补救手术或内窥镜在治疗使得再复发的或不完全切除的病变得到了成功的处理。在随访期间没有疾病相关和治疗相关的死亡。.结论：对于早期胃黏膜癌的患者来说EMR是一个能获得行之有效的临床结果的安全的治疗方法。.必须强调选择合适的患者对改善早期胃癌黏膜切除术治疗的实际临床结果有着重要的影响。