在早期直肠瘤中TEM或ESD:临床和成本效益分析
Laura Beyer-Berjot1, Coralie Delettrez2, Jérémie Jacques3
1Aix-Marseille University, Department of Gastrointestinal Surgery, APHM, Hôpital Nord, Marseille, France,.
Gastroenterology
|January 31, 2026
概括
在早期的直肠瘤 (ERT) 中,内镜下粘膜切割 (ESD) 比跨内镜显微手术 (TEM) 更具成本效益. 此外,ESD还提供更高质量的切除和更低的复发率,使其成为ERT治疗的优越选择.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 卫生经济学 卫生经济学
背景情况:
- 对于早期直肠瘤 (ERT) 的内镜下粘膜剖析 (ESD) 与过内镜显微手术 (TEM) 的比较有效性和成本效益仍在争论中.
- 现有的比较仅限于回顾性,单一中心研究,缺乏健康经济评估.
研究的目的:
- 进行成本效益分析,比较ERT切除的ESD和TEM.
- 评估完整切除的初级结果和二次结果,包括阻断切除,发病率,生活质量和生存率.
主要方法:
- 一个非随机的,比较的,多中心研究与成本效益分析.
- 纳入标准:易受ESD或TEM影响的ERT (腺瘤, in situ和usT1N0癌症).
- 医疗保健系统的前景,为成本评估提供一年的时间,以基线共变量进行调整.
主要成果:
- 在完全切除2500欧元的支付意愿下,ESD表现出显著的增量净货币收益 (1797欧元),这表明成本效益更高.
- ESD显示出更高的封锁切除率 (99%与92.5%相比),在总体或主要发病率上没有显著差异.
- 在3年后,ESD与明显更高的无病生存率相关 (94.3%与84.6%,调整HR=3.55).
结论:
- 内镜下粘膜切割 (ESD) 比对早期直肠瘤 (ERT) 的跨内镜显微手术 (TEM) 更具成本效益.
- 与TEM相比,ESD提供了更高质量的消毒和更低的复发率.
- 基于成本效益和瘤结果,ESD是ERT切除的首选方法.
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