内镜黏膜下剥离术治疗SiewertⅡ型胃食管交界早期癌及癌前病变的临床分析  

Effectiveness and safety of endoscopic submucosal dissection for Siewert typeⅡearly esophagogastric junction cancer and precancerous lesion

作　　者：刘冠伊 戎龙[1] 蔡云龙[1] 年卫东[1] 张继新[2] Liu Guanyi;Rong Long;Cai Yunlong;Nian Weidong;Zhang Jixin(Endoscopy Center,Peking University First Hospital,Beijing 100034,China;Department of Pathology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内镜中心,100034 [2]北京大学第一医院病理科,100034

出　　处：《中华消化内镜杂志》2021年第9期718-722,共5页Chinese Journal of Digestive Endoscopy

基　　金：北京大学第一医院科研种子基金(2019SF20)。

摘　　要：目的探讨内镜黏膜下剥离术(endoscopic submucosal resection,ESD)治疗胃食管交界早期癌及癌前病变的安全性和有效性。方法回顾性分析2012年7月—2019年6月间在北京大学第一医院内镜中心接受ESD治疗的67例SiewertⅡ型胃食管交界早期癌及癌前病变患者资料,对病变的临床病理特征、整块切除率、完全切除率、治愈性切除率、并发症发生率进行统计分析,并对可能影响治愈性切除的因素进行分析。结果67例病变中隆起型病变5例,浅表型病变59例,凹陷型病变3例。病变中位直径1.6(1.8)cm,中位手术时间60.0(56.0)min。整块切除率97.0%(65/67),完全切除率91.0%(61/67),治愈性切除率82.1%(55/67)。肿瘤最大径(OR=8.457,95%CI:1.227~58.302,P=0.030)及病理类型(OR=15.133,95%CI:1.518~150.870,P=0.021)与非治愈性切除相关。3例(4.5%)患者发生ESD相关并发症,1例术后迟发出血,内镜下止血后好转;2例术后瘢痕狭窄,内镜引导下探条扩张后好转。58例随访患者中1例垂直切缘阳性且未接受后续治疗的患者出现复发;1例患者随访中发现异时性早期胃癌,再次ESD切除。结论ESD治疗胃食管交界早期癌及癌前病变安全有效,操作前应对病变大小、边界、浸润深度进行准确评判,制定适宜的治疗方式及手术策略。Objective To assess the effectiveness and safety of endoscopic submucosal dissection(ESD)in the treatment of early esophagogastric junction(EGJ)cancer and precancerous lesion.Methods Clinical data of 67 patients with Siewert typeⅡearly EGJ cancer or precancerous lesion who underwent ESD at Endoscopy Center of Peking University First Hospital from July 2012 to June 2019 were retrospectively analyzed.Clinical and pathological features,technical data and complication rate were reviewed.The factors that may affect the curative resection were analyzed.Results Among the 67 cases,5 were protruding type,59 flat type,and 3 depressed type.The median lesion diameter was 1.6(QR:1.8)cm,the median operation time was 60.0(QR:56.0)min.The en bloc resection rate was 97.0%(65/67),the complete resection rate was 91.0%(61/67),and the curative resection rate was 82.1%(55/67).Factors related to non-curative resection were tumor size(OR=8.457,95%CI:1.227-58.302,P=0.030)and pathological type(OR=15.133,95%CI:1.518-150.870,P=0.021).ESD-related complications occurred in 3 cases(4.5%),including 1 case of delayed hemorrhage who received endoscopic hemostasis therapy,and 2 cases of post-operative cicatricial stricture who then received endoscopic dilation.Fifty-eight patients were followed up,and recurrence was found in 1 patient during follow-up with positive vertical margin who refused subsequent therapy.Metachronous early gastric cancer was found in another patient during follow-up,who was treated with a second ESD.Conclusion ESD is a safe,effective and less invasive technique for early EGJ cancer and precancerous lesion.Tumor size,boundary and infiltration depth of the lesion should be accurately evaluated before operation to formulate appropriate treatment strategies.

关 键 词：食管胃接合处 早期肿瘤 内镜治疗 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]