内镜黏膜下剥离术治疗早期胃癌 扩大指征的安全性分析

Security of expanded indications for early gastric cancer by endoscopic submucosal dissection

摘要:

目的 探讨内镜黏膜下剥离术治疗早期胃癌扩大指征的安全性。 方法 回顾性分析该院2005年12月~2013年5月行胃癌根治术的早期胃癌病理资料，筛选出符合内镜黏膜下剥离术扩大指征的病例，比较不同浸润深度、分化类型的淋巴结转移情况。 结果 入组157例患者中发生淋巴结转移13例。黏膜内癌（m癌）、黏膜肌层癌（mm癌）、分化型黏膜下层癌（sm1癌）的淋巴结患者转移率分别为0.0%（0/18）、6.6%（4/61）、11.5%（9/78），3组间比较（χ2=2.954，P =0.228）、m癌与mm癌比较（χ2=1.243，P =0.265）、mm癌与分化型sm1癌比较（χ2=1.002，P =0.317），差异均无显著性（P >0.05）。分化好与分化差的淋巴结转移率分别为2.3%（2/86）、15.5%（11/71），比较（χ2=8.879，P =0.003），差异具有显著性（P <0.05）。 结论 大部分符合扩大指征的早期胃癌行内镜黏膜下剥离术治疗是安全可行的，黏膜内癌更为可靠，黏膜下癌因缺乏精确的术前评价体系，需慎重选择内镜下治疗，尤其是分化程度差者，建议行胃癌根治术。

Abstract:

【Objective】 To discuss the security of expanded indications by endoscopic submucosal dissection (ESD)for early gastric cancer (EGC). 【Methods】 All the pathological materials of radical gastric resections from December 2005 to May 2013 were retrieved and the ESD's expanded indications of those cases were scanned. The risk factors relevant with lymph node metastasis,such as invasive depth and differentiation degrees, were also analyzed. 【Results】 In the recent nine years, of157 cases,13 cases had lymph node metastasis.The lymph node metastases for mucosa cancer, muscularis mucosae cancer, sm1 cancer were 0.0% (0/18), 6.6% (4/61) and 11.5% (9/78) respectively (P ＞0.05). Of 157 EGC cases, the lymph node metastases of differentiated type and poorly differentiated type were 2.3% and 15.5% ,respectively (P ＜0.05). 【Conclusion】 Most EGC cases undergoing radical gastrectomy can be cured by ESD.The mucosa cancer is more reliable, but the sm1 cancer was recommend surgery, especially with poor differentiation.