查詢結果分析
相關文獻
- EUS-based Endoscopic Resection in Elderly Patients with Early Gastric Cancer: A Single-Center Experience
- 20-MHz Ultrasonic Probe to Identify Early Gastric Cancer Suitable for Endoscopic Mucosal Resection
- Endoscopic Mucosal Resection with a Cap-Fitted Endoscope for Early Gastric Carcinoma with Focal Submucosal Invasion in a Patient with Decompensated Liver Cirrhosis
- 內視鏡黏膜下剝離術
- 失能老人家庭尋找平衡點的照顧過程及相關因素探討
- 護理於老人健康政策的重要性
- 臺灣社區老人的健康觀念與健康行為
- 活躍的銀髮族--社區老人健康體能促進方案的經驗與前瞻
- 社區殘病老人照護的挑戰
- 喪偶對社區老人身體、精神及社會功能之影響
頁籤選單縮合
題 名 | EUS-based Endoscopic Resection in Elderly Patients with Early Gastric Cancer: A Single-Center Experience=內視鏡超音波協助下使用內視鏡切除術於老人早期胃癌之單一醫學中心經驗 |
---|---|
作 者 | 范峻維; 林淳榮; 宋昌穆; 陳聰興; 許振銘; 林偉彬; 蘇銘堯; 陳澤卿; 邱正堂; | 書刊名 | 臺灣消化醫學雜誌 |
卷 期 | 30:1 2013.03[民102.03] |
頁 次 | 頁1-10 |
分類號 | 416.243 |
關鍵詞 | 早期胃癌; 內視鏡黏膜切除術; 老人; 內視鏡超音波檢查; Early gastric cancer; Endoscopic mucosal resection; Elderly; Endoscopic ultrasonography; |
語 文 | 英文(English) |
中文摘要 | 研究動機:近年來,因為內視鏡技術與設備的進步,非外科手術切除治療早期胃癌方式,如內視鏡黏膜切除術(EMR)和黏膜下剝離術(ESD)已被接受是有效且受歡迎的另一種選擇。因為侵襲性較小且可以保存器官,推論上對於年長者,所剩餘命不多,且有高手術後併發症與合併症的病人可能會有好處。因此本篇研究在內視鏡超音波協助篩選下,對於黏膜切除術應用在老人早期胃癌的效果與安全性的評估。材料與方法:此回溯性研究收集了2000至2011年,年齡65歲或以上之患者接受內視鏡切除早期胃癌的病人。所有病人都接受術前電腦斷層與內視鏡超音波來分期與篩選。18個病人接受ESD,17個病人接受EMR。我們比較這兩組的人口參數,臨床表現,術前評估(包含內視鏡型態、內視鏡超音波、電腦斷層),術中所花的時間,術後併發症與存活率。結果:35位病人,(22位男性,13位女性),平均年齡中位數是72歲(範圍65-90歲)。最常見的症狀是腹痛(54%)、貧血(45.7%)、解血便(20%);主要合併症有高血壓(54.9%)、糖尿病(22.9%)、心血管疾病(20%);經統計分析,ESD組所花的時間比EMR的時間要多(174分鐘vs. 24.6分鐘,P < 0.001),在其他部分的比較,則無統計上的顯著意義。≦ 2 cm的病灶,依次切除率的比較:EMR組41% vs. ESD組53%,P = 0.261;> 2 cm的病灶,ESD組比上EMR組的一次切除(66.7% vs. 50%,P = 0.135)。兩組延遲性出血:ESD組比上EMR組的是16.7% vs. 4%(P = 0.833)。在ESD組有一位有胃穿孔。兩組各有一位在追蹤期間發生復發。無因胃癌相關的死亡發生。存活率上兩組也並沒有顯著差異。討論和結論:由單一醫學中心資料分析,內視鏡切除(EMR或ESD)對年長換早期胃癌者皆有不錯的完整切除,與臨床結果。對年紀大有多重合併症病高麻醉手術風險的病人是另一種可以選擇的治療方式。在有足夠的經驗與訓練操作下,內視鏡超音波可作為在篩選適合內視鏡切除病人的術前評估期別與術後追蹤復發的工具。 |
英文摘要 | Background and Aim: In recent decades, as endoscopic technique and instruments are improved, endoscopic resection techniques, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), have all been accepted as effective and popular treatment choices in addition to surgical resection for early gastric cancer (EGC). Because of the advantages of lower invasiveness and organ preservation, it might be also assumed beneficial for elderly patients at high risk of postoperative complications and comorbidities and who have a limited life expectancy. This study was conducted to evaluate the efficacy and safety of endoscopic resection for the treatment of EGC in elderly patients based on the use of endoscopic ultrasound (EUS) selection in one medical center. Materials and Methods: From July 2000 to January 2011, elderly patients (those older than 65 years) who had undergone EMR or ESD for early gastric cancer were retrospectively analyzed. All the patients received pretreatment staging including computed tomography (CT) and EUS. The patients who had obvious muscularis propria invasion, perigastric lymph nodes, or distant metastasis were all excluded. The demographic characteristics, comorbidities, endoscopic morphological features and resection methods, complications, clinical outcomes, and survival time on follow-up were all recorded. Results: A total of 35 elderly patients (median age, 72 years; range, 65-90 years) received endoscopic resection for EGC. The major comorbidities included hypertension (54.3%), diabetes mellitus (22.9%), and coronary artery disease (20%). ESD was performed in 18 patients (ESD group), and EMR was performed in 17 patients (EMR group). The ESD group required longer procedure times than the EMR group (174 minutes vs. 24.6 minutes, P < 0.001). For tumors < 20 mm, the en block rate in the ESD group versus the EMR group was 41% (5/12) versus 53% (8/15; P = 0.261), respectively. For tumors > 20 mm, the en block rate in the ESD group versus the EMR group was 66.67% (4/6) versus 50% (1/2; P = 0.135), respectively. The delayed bleeding rates in the ESD and EMR groups were 15.7% and 4% (P = 0.833), respectively. Only 1 patient in the ESD group had a perforation. There was 1 local recurrence in each group of patients during the follow-up. No disease-related mortality was observed. There was no survival difference between the groups. Conclusion: In our study, endoscopic resections (either ESD or EMR) had comparable complete resection rates and clinical outcomes for elderly patients with EGC. It may be beneficial as an alternative choice for patients with comorbidities and high surgical risk. EUS is a useful modality for patients with EMR/ESD for preprocedure staging and evaluation of retreatment of local recurrence. |
本系統中英文摘要資訊取自各篇刊載內容。