内镜下黏膜剥离术及外科手术治疗137例早期胃癌的临床分析  

Clinical analysis of 137 cases of early gastric cancer in ESD and surgical operation

作　　者：姚镇东 徐刚[1] 万荣[1] 徐敏[1] 

机构地区：[1]上海市第一人民医院消化科,上海200000

出　　处：《中国中西医结合消化杂志》2016年第10期754-757,761,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的]分析我院137例早期胃癌患者的临床表现,肿瘤部位、大小、内镜形态、病理学分型、淋巴结转移等,比较内镜下黏膜剥离术（ESD）与外科手术治疗早期胃癌术后病理特征及疗效的差异,有助于选择合适的治疗方案。[方法]将2005年1月-2015年6月我院进行治疗的137例早期胃癌患者行回顾性分析和总结。应用χ2检验及独立样本t检验进行统计学分析。[结果]2005年1月-2015年6月共诊断新发早期胃癌137例,淋巴结转移率为7.30%（10/137）,其中黏膜内癌转移率为2.36%（2/85）,黏膜下癌转移率为15.38%（8/52）。经单因素χ2检验提示浸润深度与组织学分型及淋巴结转移相关,ESD术后并发症及住院费用、住院天数显著低于外科手术。[结论]目前经外科治疗的早期胃癌中接近一半的患者可经ESD治愈。早期胃癌患者中仍有部分患者术后病理见淋巴结转移且与肿瘤的黏膜浸润深度相关。胃镜下诊断胃癌需要熟练掌握其特征并善于结合病理活检。ESD早期胃癌治疗存在其优越性,在诊断淋巴结转移方面需要进一步完善。[Objective]To analyze the clinical manifestations,tumor location,size,endoscopic morphology,histological type andlymph node metastasis in 137 patients of early gastric cancer,compare the postoperative pathological characteristics and the curative effect of endoscopic submucosal dissection（ESD）with those of surgery in early gastric cancer,so as to select the appropriate treatment.[Methods]A retrospective analysis of 137 cases of early gastric cancer in our hospital in 10 years was conducted.The chi square test and independent sample t test were used for statistical analysis.[Results]A total of 137 cases of early gastric cancerpatients were diagnosed from January 2005 to June 2015.Lymph node metastasis rate was 7.30%（10/137）,with mucosal carcinoma 2.36%（2/85）,and submucosal carcinoma 15.38%（8/52）.Univariate analysis revealed that the factors influencing the depth of infiltration were lymph node metastasis and histological type.The postoperative complications and hospitalization expenses and hospitalization days of ESD were significantly lower than those of surgical operation.[Conclusion]Nearly half of the patients with early gastric cancer treated by surgical treatment can be cured by ESD.In patients with early gastric cancer,there were still some patients who had lymph node metastasis and the depth of invasion was related to the lymph node metastasis.Endoscopic diagnosis of gastric cancer requires a good grasp of its characteristics and good combination of pathological biopsy.ESD has its advantages in the treatment of early gastric cancer,however it needs to be further improved in the diagnosis of lymph node metastasis.

关 键 词：早期胃癌 诊断 胃镜 内镜下黏膜剥离术 

分 类 号：R735.2[医药卫生—肿瘤]