The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer
The utility of endoscopic ultrasonography and endoscopy in the endoscopic mucosal resection of early gastric cancer
复制标题
超声内镜与内镜在早期胃癌内镜黏膜切除术中的应用
作者：
S. Ohashi;Kose Segawa;S. Okamura;M. Mitake;H. Urano;M. Shimodaira;T. Takeda;S. Kanamori;Takehito Naito;K. Takeda;B. Itoh;H. Goto;Y. Niwa;T. Hayakawa
目的探讨超声内镜（EUS）和内镜在早期胃癌内镜下黏膜切除术（EMR）中的应用价值。对49例EMR前行EUS检查的患者进行了肿瘤浸润深度评估的准确性研究。48例患者仅接受内镜治疗;在这些患者中，EUS和内镜检查结果与临床病程相关。结果46例患者EUS显示黏膜下层及深层结构无改变。病理学上，这些患者包括37例粘膜癌和9例粘膜下癌，表现出非常轻微的粘膜下浸润。3例患者在EUS上显示粘膜下层弥漫性低回声改变;病理学上，其中2例为粘膜下层癌，1例为粘膜癌，肿瘤病灶内有消化性溃疡瘢痕。在48例仅接受内镜治疗的患者中，45例在EUS和内镜检查中未显示肿瘤复发或转移证据。观察到3例复发。其中2例患者接受了外科胃切除术，1例患者再次接受内镜治疗。在前一种情况下，手术结果与EUS和内窥镜评估相关。此外，后一名患者在EUS和内窥镜检查评估后再次接受内窥镜治疗，迄今为止没有复发。结论EUS和内镜联合应用可有效诊断EMR患者的肿瘤浸润深度，并可在随访中明确解剖层面内和层面间的变化。
OBJECTIVE To clarify the usefulness of endoscopic ultrasonography (EUS) and endoscopy in the endoscopic mucosal resection (EMR) of early gastric cancer.Patients/Methods—EMR was performed in 61 patients with early gastric cancer over the past five years. The accuracy of the assessment of the depth of cancerous invasion was studied in 49 patients who had EUS before EMR. Forty eight patients were treated with endoscopy alone; in these patients, EUS and endoscopic findings correlated with the clinical course. RESULTS Forty six patients showed no changes in the submucosal layer or deeper structures on EUS. Pathologically these included 37 patients with mucosal cancer and nine with submucosal cancer showing very slight submucosal infiltration. Three patients showed diffuse low echo changes in the submucosal layer on EUS; pathologically, these included two with submucosal cancer and one with mucosal cancer with a peptic ulcer scar within the tumour focus. Of 48 patients receiving endoscopic treatment alone, 45 showed no tumour recurrence or evidence of metastases on EUS and endoscopy. Three cases of recurrence were observed. Two of these patients had a surgical gastrectomy, and one was re-treated endoscopically. In the former cases, the surgical results correlated well with assessment by EUS and endoscopy. In addition, the latter patient who was re-treated endoscopically after evaluation with EUS and endoscopy has so far had no recurrence. CONCLUSION The combined use of EUS and endoscopy is effective in diagnosing the depth of cancerous invasion in patients undergoing EMR as well as in clarifying changes both within and between anatomic levels during follow up.