内镜黏膜下剥离术治疗早期胃癌可行性及手术指征分析  

Feasibility and surgery indications of endoscopic submucosal dissection for gastric cancers

作　　者：陈坚[1] 周仲文[2] 邱志兵[1] 黄剑平[1] 钟良[1] 

机构地区：[1]复旦大学附属华山医院消化科,上海200040 [2]复旦大学附属华山医院病理科,上海200040

出　　处：《中华消化内镜杂志》2013年第1期25-27,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的回顾分析手术治疗的早期胃癌病理资料，探讨早期胃癌行内镜黏膜下剥离术（ESD）的可行性和手术指征。方法收集上海华山医院2007至2011年间经手术治疗的胃癌病理资料，分析符合日本胃癌协会ESD治疗标准的早期胃癌的情况。比较不同浸润深度、分化类型的早期胃癌局部转移的情况。结果2007至2011年间共手术治疗胃癌1159例，其中早期胃癌210例（18．1％），有151例符合ESD扩大指征，126例符合ESD标准适应证，分别占胃癌手术量的13．0%、10．9％，占早期胃癌的71．9%、60．0％。在210例早期胃癌中，黏膜内癌（m癌）、黏膜肌层癌（mm癌）、黏膜下层第1层癌（sm1癌）、黏膜下层第2层癌（sm2癌）的局部转移率分别为6．8％（5／74）、15．0%（6／40）、23．3％（10／43）、39．6％（21／53），组间比较差异有统计学意义（P〈0．01）。分化型早癌与非分化型早癌的局部转移率分别为14．0％（24／172）、47．4％（18／38）（P〈0．01）。结论行胃癌根治术的早期胃癌患者较大部分可以选择ESD治疗。早期胃癌的区域转移与浸润深度和分化程度明显相关，故有必要严格掌握ESD的适用指征。Objective To evaluate the feasibility and indications of endoscopic submucosal dissec- tion （ESD） by analyzing the early gastric cancer cases. Methods All the pathological materials of radical gastric resections in Huashan hospital from 2007 to 2011 were retrieved and the EGC cases were selected. All the cases in EGC group which met the extended ESD criteria were reviewed. Extended ESD criteria were cited from ＂Treatment guidelines for gastric cancer in Japan＂ edited by JGCA in 2001. The risk factors rele- vant with regional metastasis, such as invasive depth and differentiation degrees, were also analysed. Results In the recent five years, there were 1159 cases of gastric cancer undergoing radical gastrectomy in Huashan hospital including 210 EGC. According to the extended criteria of JGCA, 151 cases could be candidates for ESD while 126 cases could be candidates for ESD according to the typical criteria for ESD. The local metastases of lymphatic or vascular involvement for mucosa cancer, muscularis mucosae cancer, sm1 and sm2 cancer were 6. 75%, 15.00%, 23.25%, and 39. 62% respectively （P 〈0. 05）. Twenty-five cases had local metastases that met the extended criteria for ESD. Within the 210 EGC cases, the local metastases of differentiated type and undifferentiated type were 13.95% and 47.37% respectively （P 〈 0. 05 ）. Conclusion Most EGC cases undergoing radical gastrectomy can be cured by ESD. Its metastases are highly corre- lated with invasion depth and differentiation, so indications of ESD should be assessed.

关 键 词：胃肿瘤 早期胃癌 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]