早期胃癌内镜下切除术后复发的相关因素分析

Factors for the recurrence after endoscopic resection of early gastric cancer

目的 探讨早期胃癌内镜下切除术后复发的相关性因素.方法 回顾性分析解放军总医院169例早期胃癌经内镜下切除治疗并定期随访患者的临床病理资料.结果 随访时间13～57个月（中位时间24.5个月）,169例患者中12例出现胃癌复发,总复发率为7.10%,复发时间为3～36（28±23）个月,中位时间18个月,0.5、1、2、3年的复发率分别为1.18%（2/169）、3.55%（6/169）、9.91%（11/111）、12.24%（12/98）.12例复发患者有11例发生在2年以内,其中组织分化不良（低分化腺癌和印戒细胞癌）、浸润至黏膜下层、有淋巴管浸润的早期胃癌容易出现术后复发（P＜0.05）.结论 早期胃癌内镜下切除术后的复发多出现在2年以内.组织分化不良、肿瘤浸润至黏膜下层及有淋巴管浸润是术后复发的危险因素,严谨的内镜随访对于这些患者尤为重要.

Objective To investigate the related factors of recurrence of early gastric cancer （EGC） after endoscopic resection. Methods Clinicopathologic data of 169 patients with EGC who underwent endoscopic resection and periodically followed up by the Chinese PLA General hospital were analyzed retrospectively. Results During a follow-up of 13-57 months （median time 24. 5 months）, 12patients had gastric cancer again and the recurrence rate was 7. 1% （12/169）. The recurrence time varied from 3 to 36 （28 ± 23）months and the median time was 18 months. The recurrence rates of 0.5 year, 1st year, 2nd year and 3rd year were 1.18% （2/169）, 3.55% （6/169）, 9.91% （11/111） and 12.24%（12/98）, respectively. Eleven patients had gastric cancer again within 2 years after resection.Undifferentiated histology （including poorly differentiated carcinoma and signet ring cell carcinoma）,submucosal infiltration and lymphovascular invasion of the primary lesion of EGC were related to thepostsurgical recurrence （ all P 〈 0. 05）. Conclusion Most recurrence of EGC occurred within 2 years afterendoscopic resecton and is related with undifferentiated histology, submucosal infiltration andlymphovascular invasion. It is important for these patients to receive endoscopy follow up.