单中心早期胃癌内镜下治疗10年回顾性研究

A retrospective study of endoscopic treatment on early gastric cancer in a single center for 10 years

摘要:

目的：探讨早期胃癌内镜下治疗的疗效、安全性及其影响因素。 方法：回顾性分析2006年1月至2015年12月于北京协和医院消化内镜中心拟诊早期胃癌、接受内镜下治疗并证实的病例186例次，根据内镜下治疗适应证分组，统计治愈性切除率及并发症的发生率，分析其影响因素。统计随访事件的发生情况。 结果：研究期间，接受内镜下切除的早期胃癌共186例次，绝对适应证组治愈性切除率86.9%（73/84），扩大适应证组61.7%（50/81），非适应证组33.3%（7/21），不同适应证组治愈性切除率有显著差异（P<0.01）。多因素分析显示，胃下1/3、无溃疡、直径≤2cm、无黏连、分化型癌均为治愈性切除的独立预测因素。病理分化程度改变或浸润深度升级是完全切除的扩大适应证病变无法达到治愈性切除的主要原因。出血及穿孔的发生率分别为4.8%（9/186）、3.8%（7/186）。胃下1/3、无黏连、整块切除的病变穿孔发生率低，差异有统计学意义。成功随访154例患者，中位随访时间22.3个月。治愈性切除者同时癌及异时癌的发生率分别为7.5%、0.9%。 结论：早期胃癌内镜下治疗的绝对适应证患者其治愈性切除率高；而扩大适应证者采取内镜下治疗需慎重。术前应进行细致的内镜评估，尤其是辨别未分化成分及垂直浸润深度。内镜治疗后应密切随访以早期发现同时癌及异时癌

Abstract:

Objective To evaluate the efficacy, safety and risk factors of endoscopic treatment for patients with early gastric cancer. Methods A retrospective study was conducted in a single center and collected data from 186 early gastric cancers in 161 patients pathologically confirmed and receiving endoscopic treatment in Peking Union Medical College Hospital from January 2006 to December 2015. The cases were divided into different groups according to indications of endoscopic treatment. The curative resection rate and complication rate were analyzed. Post-resection outcomes were evaluated by long-term surveillance. Results The curative resection rate was 86.9%（73/84）in the group with absolute indications, 61.7%（50/81）in the group with expanded indications, and 33.3%（7/21）in the group without indications (P<0.01). Multivariate analysis revealed that the significant independent predictors for curative resection included lower third location of stomach, no ulceration, ≤2 cm at diameter, no adhesion, and well-differentiation in histopathology. In the expanded indication group, discordance of differentiation type and deeper invasion mainly resulted in non-curative resection in en bloc lesions. The rate of bleeding and perforation was 4.8% (9/186) and 3.8% (7/186), respectively. The perforation rate was significantly lower in the lesions located in the lower third of stomach, without adhesion or performed by en bloc resection. During a median follow-up period of 22.3 months, 154 patients were followed successfully. The incidence of synchronous and metachronous gastric cancers in curative resected lesions was 7.5% (8/106) and 0.9% (1/106), respectively. Conclusion Endoscopic resection is an optimal treatment with high curative rate for early gastric cancer patients with absolute indications. Patients with expanded indications should take precise preoperative evaluation to avoid higher risk of non-curative resection endoscopically. Close follow-up is necessary for synchronous and metachronous gastric cancers after endoscopic resection.