[Recent advances in endoscopic mucosal resection for early gastric cancer].
[Recent advances in endoscopic mucosal resection for early gastric cancer].
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早期胃癌内镜下黏膜切除术的最新进展[J].
DOI：
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
S. Yoshida
中科院分区：
文献类型：
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作者：
K. Hosokawa;S. Yoshida
我们的内镜粘膜切除术（EMR）作为根治性治疗早期胃癌（EGC）的适应症如下：1）组织学：肠型; 2）肉眼可见的类型：IIa和IIc; 3）无溃疡性改变。我们不限制病变的大小。EMR是对怀疑有粘膜下浸润的病变进行诊断的。近年来，EMR病例占EGC病例总数的比例不断增加，1996年在国立癌症中心医院治疗的EGC中约占40%。从1987年到1996年，我们在国家癌症中心医院和国家癌症中心医院东部共收集了440例EGCs（肠型，组织学）。85例（19.3%）有粘膜下浸润，判断为非根治性切除。无切端病例的总体比率为72.3%，而治愈性切除（不包括粘膜下浸润病例）的总体比率为63.0%。虽然我们有37例EMR后复发的病例，但没有因原发疾病而额外治疗或观察（由于并发症或年龄）而死亡的病例。各时期（87-'90、91-' 93、94-'96）的无切端率分别为53.1%、61.3%和81.6%。病灶平均直径在各期均增大，分别为11.9mm、12.0mm和14.0mm。为了整块切除较大的病变，我们开始EMR，使用95年新改进的内窥镜设备，称为绝缘尖端透热刀（IT刀），切割病变周围的粘膜。使用这种IT刀，我们可以一次性切除75%的11-20 mm大小的病变，而使用传统方法（条带活检）可以切除29%。近年来，EMR的疗效不断提高，但仍期待新的内镜技术能使EMR的切除更容易、更可靠。
Our indications of endoscopic mucosal resection (EMR) for early gastric cancer (EGC) as a radical treatment are as follows: 1) histology: intestinal type; 2) macroscopic type: IIa and IIc; 3) without ulcerative change. We do not put restrictions on the size of the lesion. EMR is performed on lesions which are suspected to have submucosal invasion for a diagnostic purpose. The ratio of EMR cases to the total EGC cases is increasing in recent years and amounted to about 40% of EGCs treated at the National Cancer Center Hospital in '96. From '87-'96, we had 440 cases of EGCs (intestinal type, histologically) at the National Cancer Center Hospital and National Cancer Center Hospital East. Eighty-five cases (19.3%) turned out to have submucosal invasion and judged non-curative resection. The overall rate of cut-end-free cases was 72.3%, while the overall rate of curative resection (excluding cases with submucosal invasion) was 63.0%. Though we had 37 cases of recurrence after EMR, there were no cases of death from the original disease with additional treatment or observation (due to complication or age). The cut-end-free rates of each period ('87-'90, '91-'93, '94-'96) were 53.1%, 61.3% and 81.6%, respectively. The mean diameter of the lesion of each period became larger, at 11.9 mm, 12.0 mm and 14.0 mm, respectively. To resect a larger lesion in one piece, we began EMR with cutting the mucosa around the lesion using a newly improved endoscopic device called an insulation-tipped diathermic knife (IT knife) from '95. With this IT knife, we could resect 75% of the lesions sized 11-20 mm in one piece, while we could resect 29% with the conventional method (strip biopsy). Though the results of EMR are improving in recent years, new endoscopic technics of EMR to resect easily and surely are expected.