符合内镜黏膜下剥离术扩大适应证的早期胃癌内镜与外科手术回顾性比较研究  

A retrospective comparative analysis between endoscopic treatment and surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection

作　　者：李风[1] 项平[1] 欧阳琪[1] 黄任翔[1] Li Feng;Xiang Ping;Ouyang Qi;Huang Renxiang(Department of Digestive Endoscopy,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,Chin)

机构地区：[1]复旦大学附属华东医院消化内镜室,上海200040

出　　处：《中华消化内镜杂志》2018年第7期486-491,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨符合内镜黏膜下剥离术（ESD）扩大适应证的早期胃癌，内镜与外科手术切除在疗效和并发症发生率方面是否存在显著差异。方法2011年1月到2016年12月，行ESD切除（ESD组，77例）或外科手术切除（手术组，88例）的165例患者共167个早期胃癌病灶纳入回顾性研究。纳入研究的早期胃癌满足ESD扩大适应证，最终病理确认为分化型或未分化型腺癌。采用卡方检验、连续性校正卡方检验或Fisher确切概率法分析病灶残留、局部复发、异时癌、短期并发症和长期并发症发生率。采用Kaplan-Meier法分析两组3年完全生存率和无病生存率。结果ESD组和外科手术组在病灶残留发生率（P=0．473）、局部复发率（P=1．000）和异时癌发生率（P=1．000）方面相似。两组间3年完全生存率（100．0％比98．3％，P=0．343）和3年无病生存率（98．1％比96．7％，P=0．655）均无明显差异。两组短期并发症发生率无明显差异[7．8％（6／77）比5．7％（5／88）,χ^2=0．294，P=0．588]，而长期并发症发生率ESD组低于外科手术组[0（0／77）比8．0％（7／88），连续性校正卡方检验爿。4．588，P=0．032]。结论对于符合扩大适应证的早期胃癌，与传统外科手术相比，ESD在疗效上无显著差异，而长期并发症的发生率低于外科手术。Objective To compare the efficacy of endoscopic treatment with surgical treatment for early gastric cancer accorded with expanded indications of endoscopic submucosal dissection （ESD）. Methods A total of 165 patients （ 167 lesions） with early gastric cancer underwent ESD （ ESD group, 77 cases） or surgery （surgery group, 88 cases） from January 2011 to December 2016. The lesions fulfilled expanded indications of ESD, and were pathologically identified as differentiated or undifferentiated adenocarcinoma. Chi-square test, continuity-adjusted Chi square test, and Fisher exact test were used to analyze the incidence of lesion residual, local recurrence, metachronous recurrence, short-term complications and long-term complications. The 3-year overall survival rate and 3-year disease-free survival rate of the two groups were analyzed by Kaplan-Meier method. Results There were no differences on the incidence of lesion residual （ P = 0. 473） , local recurrence （ P = 1. 000） and metachronous recurrence （ P = 1. 000） between the ESD group and the surgery group. The 3-year overall survival rate （100. 0% VS 98.3%, P= 0. 343） and the 3-year disease-free survival rate （98. 1% VS 96. 7%, P = 0. 655） were not significantly different between the two groups. There was no significant difference on the incidence of short- term complications between the two groups [ 7.8% （6/77） VS 5.7% （5/88）, χ^2 = 0. 294, P = 0. 588 ]. The incidence of long-term complications in the ESD group was lower than that in the surgery group [ 0 （ 0/77 ） VS 8.0% （7/88）, continuity-adjusted χ^2 = 4. 588, P= 0. 032 ]. Conclusion For patients with early gastric cancer fulfilled expanded indications of ESD, ESD has a lower incidence of long-term complications with similar efficacy compared to surgery.

关 键 词：回顾性研究 胃肿瘤 外科手术 内镜黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]