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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (05): 283 -287. doi: 10.3877/cma.j.issn.1674-6899.2020.05.007

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内镜黏膜下剥离术与外科切除治疗早期残胃癌长期疗效的比较研究
李慧 1, 令狐恩强 1, 李隆松 1, 向京元 1, 杜红 1, 唐平 1, 柴宁莉 1 , †( )   
  1. 1. 100853 北京，解放军总医院第一医学中心消化内科
  • 收稿日期:2020-07-25 出版日期:2020-10-30
  • 通信作者: 柴宁莉
  • 基金资助:
    首都临床特色应用研究(Z181100001718177)

Comparison of long-term efficacy of endoscopic submucosal dissection and surgical resection for early gastric stump cancer

Hui Li 1, Enqiang Linghu 1, Longsong Li 1, Jingyuan Xiang 1, Hong Du 1, Ping Tang 1, Ningli Chai 1 , †( )   

  1. 1. Department of Gastroenterology, the First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China
  • Received:2020-07-25 Published:2020-10-30
  • Corresponding author: Ningli Chai
  • About author:
    Corresponding author: Chai Ningli, Email:
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目的

本研究旨在对内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)与外科手术切除治疗胃癌外科R0切除术后早期残胃癌(early remnant gastric cancer，ERGC)的远期疗效进行比较。

方法

收集2008年1月至2016年12月就诊于解放军总医院的胃癌外科R0切除术后经内镜活检诊断为ERGC患者的临床和病理资料，根据患者接受治疗措施的不同将其分为ESD治疗组和外科手术组，在2020年5月对所有患者进行电话随访。计算ESD治疗组的整块切除率、完全切除率、治愈性切除率。采用Kaplan-Meier法计算ESD组和外科手术组患者5年总生存率和病因特异性生存率，采用Log-Rank检验比较ESD组和外科手术组患者生存率的差异。

结果

共纳入ERGC患者32例，其中ESD组21例、外科手术组11例。32例ERGC患者中男性31例(96.9%)。ESD治疗组的整块切除率76.2%(16/21)、完全切除率71.4%(15/21)、治愈性切除66.7%(14/21)。ESD组及外科手术组5年总生存率差异无统计学意义(78.8%比77.1%，P＝0.764)，5年病因特异性生存率差异无统计学意义(78.8%比90.0%，P＝0.538)。

结论

残胃空间有限及黏膜下严重纤维化都增加了ESD的难度，但ESD与外科手术切除治疗ERGC患者的长期疗效相当，ESD可作为ERGC的一种安全、有效的治疗选择。

关键词: 早期残胃癌, 内镜下黏膜下剥离术, 长期预后
Objective

To compare the long-term efficacy of endoscopic submucosal dissection (ESD) and surgical resection for early remnant gastric cancer (ERGC) after R0 resection of gastric cancer.

Methods

The clinical and pathological data of patients with gastric cancer diagnosed as ERGC by endoscopic biopsy after R0 resection in our hospital from Jan. 2008 to Dec. 2016 were collected and divided into ESD group and surgical resection group according to the different treatment measures. All patients were followed up by telephone in May 2020. The en bloc resection rate, complete resection rate and curative resection rate of ESD group were calculated. The 5-year overall survival rate and the 5-year cause specific survival rate of ESD group and surgical resection group were calculated and compared.

Results

A total of 32 patients with ERGC were included, including 21 patients in ESD group and 11 patients in surgical resection group. Among the 32 patients with ERGC, 31 (96.9%) were males. In ESD group, The en bloc resection rate was 76.2% (16/21), the complete resection rate was 71.4% (15/21), and the curative resection rate was 66.7% (14/21). There was no significant difference in 5-year overall survival rate between ESD group and surgical resection group (78.8% vs. 77.1%, P=0.764), but there was no significant difference in 5-year cause-specific survival rate (78.8% vs. 90.0%, P=0.538). Multivariate Cox regression analysis showed that invasion depth and lesion size were independent risk factors for prognosis of patients with ERGC.

Conclusions

The long-term efficacy of ESD is similar to that of surgical resection in patients with ERGC. ESD can be used as a safe and effective treatment option for ERGC, even the limited space of remnant stomach and severe submucosal fibrosis increase the difficulty of ESD.

Key words: Early remnant gastric cancer, Endoscopic submucosal dissection, Long term prognosis
图1 ESD过程
表1 早期残胃癌患者的临床特征情况
项目 ESD组(21例) 外科手术组(11例) t值 P值
年龄(岁， ±s) 65.1±10.3 60.6±8.6 1.209 0.236
性别(女性) [例(%)] 1(4.8) 0(0.0) - 1.000
既往手术部位[例(%)]     - 0.712
  近端胃部分切除 10(47.6) 4(36.4)    
  远端胃部分切除 11(52.4) 7(63.6)    
肿瘤大小(cm, ±s) 1.4±0.8 1.5±0.8 -0.467 0.645
组织学类型[例(%)]     - 0.106
  分化型 20(95.2) 8(72.7)    
  未分化型 1(4.8) 3(27.3)    
浸润深度[例(%)]     - 0.037
  黏膜层 20(95.2) 7(63.6)    
  黏膜下层 1(4.8) 4(36.4)    
病变形态[例(%)]     - 0.232
  平坦型 8(38.1) 1(9.1)    
  凹陷型 5(23.8) 5(45.4)    
  隆起型 8(38.1) 5(45.4)    
图2 早期残胃癌患者ESD组和外科手术组总体生存情况
图3 早期残胃癌患者ESD组和外科手术组肿瘤特异性生存情况
表2 早期残胃癌患者总体生存影响因素筛选
项目 Coefficient SE Wald P HR (95%CI)
浸入深度(黏膜下层比黏膜层) 2.155 0.993 4.705 0.030 8.63 (1.23～60.45)
病变大小(每增加1 cm) 1.343 0.593 5.135 0.023 3.83 (1.20～12.24)
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