未分化型早期胃癌内镜下黏膜剥离术治疗效果分析  

Effect of endoscopic mucosal dissection for undifferentiated early gastric cancer

作　　者：张希 邵琳琳 李鹏 冀明 张澍田 ZHANG Xi;SHAO Lin-lin;LI Peng;JI Ming;ZHANG Shu-tian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Faculty of Gastroenterology of Capital Medical University,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,国家消化系统疾病临床医学研究中心,首都医科大学消化病学系,消化疾病癌前病变北京市重点实验室,100050

出　　处：《现代消化及介入诊疗》2021年第10期1216-1219,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然科学基金资助项目(81902472)。

摘　　要：目的探讨内镜黏膜下剥离术(ESD)治疗未分化型早期胃癌的疗效。方法回顾性分析2017年1月至2020年1月首都医科大学附属北京友谊医院消化内镜中心行ESD治疗且术后病理证实为早期胃癌的223例患者(238处病灶)的临床病理资料,根据术后病理结果分为未分化癌组(22例,22个病灶)和分化癌组(201例,216个病灶)。收集患者一般情况、病理情况及术后随访情况等进行分析,并对不同病变范围未分化型早期胃癌患者的术后病理及术后随访情况进行回顾性分析。结果223例患者中,治愈性切除203例,非治愈性切除20例。未分化癌组治愈性切除率低于分化癌组(31.8%vs 97.5%,P<0.001),但术后1年复发情况两组间无统计学差异(4.5%vs 1.9%,P=0.408)。对于病变直径≤2 cm非溃疡性未分化型早期胃癌患者7例全部达到治愈性切除,治愈性切除率显著高于病变直径>2 cm的未分化型早期胃癌患者(P<0.001),但两组患者在整块切除比例、脉管浸润及术后局部复发方面无显著差异(P>0.05)。结论未分化型早期胃癌治愈性切除率低于分化型早期胃癌,但病变直径≤2 cm非溃疡性未分化型早期胃癌患者治愈性切除率高ESD治疗有效。Objective To evaluate the efficacy of endoscopic submucosal dissection(ESD)in the treatment of undifferentiated early gastric cancer.Methods The pathological data of 223 patients(238 lesions)with early gastric cancer who underwent ESD treatment in digestive endoscopy center of Beijing Friendship Hospital from January 2017 to January 2020 were retrospectively analyzed.According to the postoperative pathological results,they were divided into undifferentiated cancer group(22 cases,22 lesions)and differentiated cancer group(201 lesions).Pathology and postoperative follow-up were collected and analyzed.The postoperative pathology and postoperative follow-up of patients with undifferentiated early gastric cancer in different lesion areas were analyzed retrospectively.Results Among 223 cases,203 cases were cured resection and 20 cases were non-cured resection.The curative resection rate of undifferentiated cancer group was lower than that of differentiated cancer group[31.8%(7/22)vs.97.5%(196/201),2=104.822,P<0.001],but there was no significant difference in 1-year recurrence between the two groups[4.5%(1/22)vs.1.9%(4/201),2=0.697,P=0.408].All 7 patients with non ulcerative undifferentiated early gastric cancer with lesion diameter≤2 cm achieved curative resection.The curative resection rate was significantly higher than that of undifferentiated early gastric cancer with lesion diameter>2 cm(P<0.001),but there was no significant difference in the proportion of whole resection,vascular infiltration and postoperative local recurrence between the two groups(P>0.05).Conclusion The curative resection rate of undifferentiated early gastric cancer is lower than that of differentiated early gastric cancer,but the curative resection rate of non ulcerative undifferentiated early gastric cancer patients with lesion diameter≤2 cm is high and ESD treatment is effective.

关 键 词：未分化型早期胃癌 内镜黏膜下剥离术 治疗 预后 病理 

分 类 号：R735.2[医药卫生—肿瘤] R573[医药卫生—临床医学]