内镜下黏膜切除术与内镜黏膜下剥离术治疗早期食管癌及癌前病变的有效性及安全性分析
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摘要
[目的]比较内镜下黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)治疗早期食管癌及癌前病变有效性及安全性的差异。[方法]检索自建库以来至2017年11月在Embase、Pubmed、Cochrane Library、中国知网、万方及维普上的有关EMR与ESD治疗早期食管癌及癌前病变的对比研究。根据纳入和排除标准对文献进行筛选,应用Revman 5.3软件进行Meta分析。[结果]共纳入20篇文献2 883个病灶。Meta分析示:ESD整块切除率、完全性切除率高,局部复发率低。ESD与EMR的出血率和术后狭窄率差异无统计学意义,但ESD穿孔率高、手术时间长。[结论]在早期食管癌及癌前病变内镜治疗方面ESD仍为首选。
[Objective]To compare the efficacy and safety of endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) in the treatment of early esophageal cancer and precancerous lesions. [Methods]A comparative study of EMR and ESD in the treatment of early esophageal cancer and precancerous lesions was performed at the PubMed,EMBASE,Cochrane Library,CNKI,Wangfang and VIP from the establishment of the library until November 2017. Meta-analysis for each outcome of the include studies that were indentified was conducted using software Revman 5.3. [Results]A total of 2 883 lesions were included in 20 articles. Meta-analysis showed that ESD had a high resection rate, a complete resection rate, and a low local recurrence rate. T There was no significant difference in the rates of bleeding and postoperative stenosis between ESD and EMR. The ESD group had a higher rate of perforation and longer operation time than the EMR group. ESD had significantly higher en bloc rate and complete resection. Local recurrence rate was significantly lower in the ESD group. [Conclusion]ESD is still the first choice in the treatment of early esophageal cancer and precancerous lesions.
[Objective]To compare the efficacy and safety of endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) in the treatment of early esophageal cancer and precancerous lesions. [Methods]A comparative study of EMR and ESD in the treatment of early esophageal cancer and precancerous lesions was performed at the PubMed,EMBASE,Cochrane Library,CNKI,Wangfang and VIP from the establishment of the library until November 2017. Meta-analysis for each outcome of the include studies that were indentified was conducted using software Revman 5.3. [Results]A total of 2 883 lesions were included in 20 articles. Meta-analysis showed that ESD had a high resection rate, a complete resection rate, and a low local recurrence rate. T There was no significant difference in the rates of bleeding and postoperative stenosis between ESD and EMR. The ESD group had a higher rate of perforation and longer operation time than the EMR group. ESD had significantly higher en bloc rate and complete resection. Local recurrence rate was significantly lower in the ESD group. [Conclusion]ESD is still the first choice in the treatment of early esophageal cancer and precancerous lesions.
引文
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[21] 陈子洋,刘晓岗,李易,等.内镜黏膜剥离术治疗早期食管癌的临床研究[J].华西医学,2013,28(2):184-186.
[22] 靳西凤.多环黏膜切除术与黏膜下剥离术治疗早期食管癌及与胸腔镜手术对比研究[D].山东大学,2016.
[23] 何梦江,李全林,陈巍峰,等.内镜分片黏膜切除术与黏膜下剥离术治疗直径大于15 mm食管黏膜病变的对比研究[J].中华消化内镜杂志,2017,34(6):389-393.
[24] 苏虹,陈进忠,刘明,等.内镜黏膜下剥离术治疗早期食管癌的疗效分析[J].中华消化内镜杂志,2017,34(1):56-58.
[25] 汪明.EMR与ESD治疗早期胃癌及其癌前病变的效果分析对比[J].中国中西医结合消化杂志,2018,26(5):426-429.
[26] 邹文斌,王贵齐,李兆申.早期食管癌及癌前病变内镜下切除治疗的发展与现状[J].中华消化内镜杂志,2014,31(9):545-548.
[27] Zhao Y,Wang C.Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer:An Updated Meta-Analysis[J].Biomed Res Int,2018,2018.
[28] Zhong H,Ma L,Zhang Y,etal.Nonsurfical treatment of 8 case with esophageal Perforations caused by ESD[J].Int J Clin Exp Med,2015,8(11):21760-21764.
[29] 李艳霞,沈磊,于红刚.内镜黏膜下剥离术治疗早期食管癌及癌前病变术后延迟性出血的危险因素分析[J].中华消化内镜杂志,2017,34(2):118-121.
[30] Isomoto H,Yamaguchi N,Minami H,et al.Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer[J].Digest Endosc,2013,25(S1):29-38.
[31] 李书香,王艳红,李增魁,张萌,赵春倩.内镜下切开术联合探条扩张术与单纯扩张法在食管良性狭窄治疗效果比较[J].中国中西医结合消化杂志,2017,25(7):540-542.
[32] 唐健,刘枫,李兆申.内镜黏膜下剥离术相关器械和操作技术的新进展[J].中华消化内镜杂志,2016,33(3):194-197.
[2] Ciocirlan M,LaPalus MG,Hervieu V,et al.Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus[J].Endoscopy,2007,39(1):24-29.
[3] Shimamura Y,Ikeya T,Marcon N,et al.Endoscopic diagnosis and treatment of early esophageal squamous neoplasia[J].World J Gastrointest Endosc,2017,9(9):438.
[4] 马丹,杨帆,廖专,等.中国早期食管癌筛查及内镜诊治专家共识意见(2014年,北京)[J].中国实用内科杂志,2015,35(4):320-337.
[5] Teoh AYB,Chiu PWY,Ngo DKY,et al.Outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection in management of superficial squamous esophageal neoplasms outside Japan[J].J Clin Gastroenterol,2010,44(9):e190-e194.
[6] Golger D,Probst A,Maerkl B,et al.Esd versus emr in esophageal adenocarcinoma(EAC)-report of a german center[J].United Eur Gastroent,2015,3(5S):A115-A116.
[7] Kim DH,Jung HY,Choi KD,et al.Long-Term Outcomes of Endoscopic Resection for Superficial Esophageal Neoplasms:Comparison Between EMR and ESD Method[J].Gastrointest Endosc,2011,73(4):AB201.
[8] Sato H,Inoue H,Ikeda H,et al.Clinical experience of esophageal Perforation occurring with endoscopic submucosal dissection[J].Dis Esophagus,2014,27(7):617-622.
[9] Takahashi H,Arimura Y,Masao H,et al.Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus(with video)[J].Gastrointest Endosc,2010,72(2):255-264.e2.
[10] Konishi J,Kobayashi N,Hirahara Y,et al.The Usefulness of Endoscopic Submucosal Dissection for Superficial Esophageal Cancers Comparing With Endoscopic Mucosal Resection[J].Gastrointest Endosc,2012,75(4):AB469.
[11] Ishihara R,Iishi H,Takeuchi Y,et al.Local recurrence of large squamous-cell carcinoma of the esophagus after endoscopic resection[J].Gastrointest Endosc,2008,67(6):799-804.
[12] Ishihara R,Iishi H,Uedo N,et al.Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan[J].Gastrointest Endosc,2008,68(6):1066-1072.
[13] Yamashita T,Zeniya A,Ishii H,et al.Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma[J].Surg Endosc,2011,25(8):2541-2546.
[14] Urabe Y,Hiyama T,Tanaka S,et al.Advantages of endoscopic submucosal dissection versus endoscopic oblique aspiration mucosectomy for superficial esophageal tumors[J].J Gastroenterol Hepatol,2011,26(2):275-280.
[15] Kubota Y,Kojima T,Fukuda D,et al.S1496:Comparison of Endoscopic Mucosal Resection(EMR)and Endoscopic Submucosal Dissection(ESD)for Large Squamous Cell Carcinoma of the Esophagus[J].Gastrointest Endosc,2010,71(5):AB177.
[16] 丁黎葭.早期食管癌及癌前病变的内镜治疗评价及Lgr5表达分析[D].复旦大学,2010.
[17] 廖春丽.EMR和ESD治疗早期食管癌及癌前病变的疗效观察[D].福建医科大学,2013.
[18] 徐敏,朱艺艺,张永,等.早期食管癌患者采用ESD和EMR治疗的效果对照研究[J].中西医结合心血管病杂志(电子版),2016,25(4):195-195.
[19] 李春.EMR与ESD对治疗直径为2 cm～3 cm的早期食管癌及癌前病变的效果对比分析[D].新疆医科大学,2014.
[20] 杨江华.食管表浅隆起型病变的内镜下诊断与治疗[D].兰州大学,2010.
[21] 陈子洋,刘晓岗,李易,等.内镜黏膜剥离术治疗早期食管癌的临床研究[J].华西医学,2013,28(2):184-186.
[22] 靳西凤.多环黏膜切除术与黏膜下剥离术治疗早期食管癌及与胸腔镜手术对比研究[D].山东大学,2016.
[23] 何梦江,李全林,陈巍峰,等.内镜分片黏膜切除术与黏膜下剥离术治疗直径大于15 mm食管黏膜病变的对比研究[J].中华消化内镜杂志,2017,34(6):389-393.
[24] 苏虹,陈进忠,刘明,等.内镜黏膜下剥离术治疗早期食管癌的疗效分析[J].中华消化内镜杂志,2017,34(1):56-58.
[25] 汪明.EMR与ESD治疗早期胃癌及其癌前病变的效果分析对比[J].中国中西医结合消化杂志,2018,26(5):426-429.
[26] 邹文斌,王贵齐,李兆申.早期食管癌及癌前病变内镜下切除治疗的发展与现状[J].中华消化内镜杂志,2014,31(9):545-548.
[27] Zhao Y,Wang C.Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer:An Updated Meta-Analysis[J].Biomed Res Int,2018,2018.
[28] Zhong H,Ma L,Zhang Y,etal.Nonsurfical treatment of 8 case with esophageal Perforations caused by ESD[J].Int J Clin Exp Med,2015,8(11):21760-21764.
[29] 李艳霞,沈磊,于红刚.内镜黏膜下剥离术治疗早期食管癌及癌前病变术后延迟性出血的危险因素分析[J].中华消化内镜杂志,2017,34(2):118-121.
[30] Isomoto H,Yamaguchi N,Minami H,et al.Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer[J].Digest Endosc,2013,25(S1):29-38.
[31] 李书香,王艳红,李增魁,张萌,赵春倩.内镜下切开术联合探条扩张术与单纯扩张法在食管良性狭窄治疗效果比较[J].中国中西医结合消化杂志,2017,25(7):540-542.
[32] 唐健,刘枫,李兆申.内镜黏膜下剥离术相关器械和操作技术的新进展[J].中华消化内镜杂志,2016,33(3):194-197.