老年早期胃癌内镜综合治疗的效果及长期随访

Long-term outcomes of endoscopic treatment of early gastric cancer in elderly patients

目的:了解早期胃癌内镜下综合治疗方案的选择及其长期效果.方法:回顾性分析1992-4/2011-12由我科诊断并进行内镜治疗的早期胃癌45病例的临床资料及其长期随访结果.结果:45例患者的癌灶50个进行了内镜治疗.45例患者共进行治疗156次或疗程.每个病灶的接受治疗方法平均为1.98种±1.21种(1-5种),治疗次数平均为3.08次±3.04次(1-14次).除1例在内镜治疗后失访外,其余均接受了胃镜定期复查随访,随访率为97.78%,平均随访时间为48.53 mo±44.96 mo(3-190 mo).经内镜治疗后,32个病灶胃镜检查并经活组织病理证实已彻底清除,病灶原位清除率为64.0%.接受随访的44例患者内镜治愈28例;癌组织残留16例:其中死于胃癌4例(均为残胃癌、均治疗7疗程、平均生存时间为42.33 mo),补充手术7例,死于其他疾病5例.经内镜治疗后,早期胃癌患者3年生存率为94.44%,5年和10年生存率均为78.70%.所有患者均耐受了内镜下胃癌的治疗,无一例发生消化系出血、穿孔等严重并发症.结论:早期胃癌内镜下治疗可以完全达到根治性效果,但残胃癌和低分化或者病损范围较大的早期胃癌不适合进行内镜下治疗.

AIM： To assess the effectiveness and safety of endoscopic methods for the treatment of early gastric cancer in elderly patients. METHODS： Forty-five consecutive patients with early gastric carcinoma （50 lesions） who underwent endoscopic treatment in the Department of Geriatric Endoscopy in General Hospital of PLA from April 1992 to December 2011 were included. Forty-four patients were followed （median, 48.53 mo ± 44.96 mo）. Endoscopic treatments included endoscopic mucosa resection （EMR）, endoscopic submucosa dissection （ESD）, argon plasma coagulation （APC）, photodynamic therapy （PDT）, laser irradiation, electrocoagulation, and submucosal injection of chemical agents. RESULTS： Each early gastric carcinoma lesion underwent endoscopic treatment by a mean of 1.98 sorts of methods and a mean of 3.08 times of treatments. In total, 32 lesions obtained radical cure by endoscopy. There were 16 patients without radical cure, of whom 7 underwent an additional operation, 4 died of gastric remnant carcinoma, and 5 died of causes other than gastric cancer. The 3-, 5- and 10-year survival rates were 94.44%, 78.70% and 78.70%, respectively. There were no serious endoscopic treatment-associated complications such as bleeding and perforation. CONCLUSION： Early gastric carcinoma can be radically cured by endoscopic methods. Endoscopic treatment is not indicated for gastric remnant carcinoma and early gastric carcinoma with low differentiation.