内镜黏膜下剥离术治疗早期胃癌及癌前病变的疗效分析

Endoscopic submucosal dissection in treatment of early gastric cancer and precancerous lesions

摘要:

探讨内镜黏膜下剥离术（ESD）治疗早期胃癌及癌前病变的疗效和风险。方法?对2011年6月-2016年12月甘肃省武威肿瘤医院内镜中心经ESD治疗的206例早期胃癌及癌前病变患者的临床病理和随访资料进行总结，评价ESD治疗的一次性完整切除率、并发症发生率、复发转移率和临床疗效。结果?206例患者中早期胃癌157例（76.21%），其中m1 39例（24.84%）、m2 17例（10.83%）、m3 92例（58.60%）、sm1 4例（2.55%）、sm2 3例（1.91%）、基底部有癌肿累及2例（1.27%），胃腺管癌84例（53.50%）、中分化腺癌61例（38.85%）、乳头状腺癌5例（3.18%）、胃黏液腺癌2例（1.27%）、胃低分化腺癌5例（3.18%）；高级别上皮内瘤变41例（19.90%）；绒毛状管状腺瘤伴低级别上皮内瘤变8例（3.88%）。ESD整块切除率为99.03%（204/206），完整切除率为98.06%（202/206），组织学完整治愈率为98.06%（202/206）。术后迟发性出血7例（3.40%），术中穿孔5例（2.43%），术后出现贲门狭窄2例（0.97%），均予保守治疗出院。随访时间9～67个月，第3和5年以上病灶复发3和2例，第3和5年总复发率分别为3.53%和4.35%；第3和5年以上死亡各2例，3和5年生存率分别为97.65%（83/85）和95.65%（44/46）。结论?ESD治疗早期胃癌及癌前病变是一种简便、安全、疗效肯定的方法，临床值得推广。

Abstract:

To explore the efficacy and risk of endoscopic submucosal dissection (ESD) for early gastric cancer and precancerous lesions.?Methods?From June 2011 to December 2016, we summarized clinical pathological and follow-up data of 206 cases of early gastric cancer and precancerous lesions patients treated with ESD, then evaluate the treatment of ESD one-time transfer complete resection rate,?syndrome and recurrence rate and clinical curative effect.?Results?206 cases of patients with early gastric cancer, 157 cases (76.21%), including m1 39 cases (24.84%), m2 17 cases (10.83%), m3 92 cases (58.60%), sm1 4 cases (2.55%), sm2 3 cases (1.91%), based with tumor involvement in 2 cases (1.27%), gastric gland duct carcinoma in 84 cases (53.50%), moderately differentiated adenocarcinoma, 61 cases (38.85%), 5 cases with papillary adenocarcinoma (3.18%), gastric mucous adenocarcinoma, 2 cases (1.27%), stomach poorly differentiated adenocarcinoma in 5 cases (3.18%), 41 cases of high level intraepithelial neoplasm (19.90%); There were 8 cases tubular adenoma with low levels of intraepithelial neoplasm (3.88%). The total cutting rate of ESD was 99.03%(204/206), the complete cutting rate was 98.06%(202/206), postoperative delayed hemorrhage in 7 cases(3.40%), intraoperative perforation in 5 cases(2.43%), and 2 cases (0.97%) of cardiac stenosis after surgery were treated with conservative treatment cardiac stenosis after surgery were treated with conservative treatment. The total recurrence rate was 3.53% and 4.35% in the third and the fifth years, The five-year survival rate was 97.65% (83/85) and 95.65% (44/46) respectively.?Conclusion?It is a simple, safe and effective method that ESD treatment of early gastric cancer and precancerous lesion.