早期食管胃结合部癌的临床病理和内镜表现特点及内镜手术效果分析

Analysis of clinicopathological and endoscopic features and endoscopic efficacy of early gastroesophageal junction cancer

摘要:

为探讨早期食管胃结合部癌的临床病理特征、内镜表现及内镜手术效果，对2014年11月至2021年10月复旦大学附属中山医院和厦门分院行内镜黏膜下剥离术治疗且术后病理证实为早期食管胃结合部癌患者的病理和胃镜表现、内镜手术切除短期效果进行回顾性分析。结果显示401例患者中：男332例、年龄（66.02±7.93）岁，女69例、年龄（66.26±9.31）岁，男女比例为4.8∶1；Siewert Ⅱ型占70.82%（284/401），累及小弯侧的病变占57.10%（229/401），内镜表现为黏膜发红占96.26%（386/401），病灶形态0‑Ⅱc 型占38.15%（153/401），管状腺癌占86.53%（347/401）；内镜黏膜下剥离术整块切除率为99.75%（400/401），治愈性切除率为72.82%（292/401）。可见，早期食管胃结合部癌好发于中老年男性，多为Siewert Ⅱ型，最常累及小弯侧，形态以0‑Ⅱc型为主，多表现为黏膜发红，以高中分化腺癌居多，内镜黏膜下剥离术治疗早期食管胃结合部癌是一种安全、有效的治疗方法。

Abstract:

To explore the clinicopathological characteristics, endoscopic manifestations, and efficacy of endoscopic procedure for early gastroesophageal junction cancer, a retrospective analysis was conducted on the patients who underwent endoscopic submucosal dissection (ESD) and pathologically confirmed early cancer of the gastroesophageal junction at Zhongshan Hospital, Fudan University and Xiamen Branch from November 2014 to October 2021. The pathological and gastroscopic features, as well as short‑term efficacy of ESD were analyzed. Among the 401 patients, there were 332 males with the age of 66.02±7.93 years, and 69 females with the age of 66.26±9.31 years. The male‑to‑female ratio was 4.8∶1. Siewert type Ⅱ accounted for 70.82% (284/401). Lesions involving the lesser curvature accounted for 57.10% (229/401). Endoscopic manifestation of mucosal erythema accounted for 96.26% (386/401). Lesion morphology of 0‑Ⅱc type accounted for 38.15% (153/401) and tubular adenocarcinoma accounted for 86.53% (347/401). The en bloc resection rate of ESD was 99.75% (400/401), with a curative resection rate of 72.82% (292/401). It is indicates that early gastroesophageal junction cancer predominantly occurs in middle‑aged and elderly males. It is mostly Siewert type Ⅱ, and involves the lesser curvature, and primarily presents as type 0‑Ⅱc morphology. The lesions are most commonly manifested as mucosal redness and are predominantly moderately to well‑differentiated adenocarcinomas. ESD demonstrates a safe and effective therapeutic approach for early gastroesophageal junction cancer.