内镜黏膜下剥离术治疗残胃腺上皮高级别上皮内瘤变及早期癌临床意义探讨

Endoscopic submucosal dissection in patients with high grade intraepithelial neoplasia and/or early cancer of remnant stomach after partial gastrectomy

目的探讨残胃腺上皮高级别上皮内瘤变／早期癌内镜黏膜下剥离术（ESD）切除的可行性、安全性与疗效。方法11例符合早期胃癌ESD适应证的残胃腺上皮高级别上皮内瘤变及早期癌施行ESD切除，记录手术时间、并发症、完整切除率及R0切除率，局部复发率及淋巴结转移率等近远期疗效和安全性指标，进行初步分析。结果11例患者完成ESD手术，平均手术时间85-5min，除1例术后迟发性出血外，未发生其他并发症。11处病变整块切除率100％，R0切除率90％，随访时间15～51个月，未见局部复发及淋巴结转移。结论ESD切除残胃腺上皮高级别上皮内瘤变／早期癌安全有效，妥善处理病变基底部纤维化组织是手术成功的关键。

Objective To evaluate the feasibility, safety and efficacy of ESD for precancerous lesions and early cancer of remnant stomach after partial gastrectomy. Methods ESD was performed in 11 cases of high grade intraepithelial neoplasia/early cancer of remnant stomach. The short-term and long-term indices including time of procedure, complication, En Bloc resection rate, R0resection rate, local recurrence rate as well as lymph node metastasis were recorded and analysed. Results ESD was completed in all patients with only one case of delayed massive bleeding which was controlled by endoscopy successfully. Average procedure time, En Bloc resection rate, R0 resection rate were 85.5 minutes, 100% and 90%, respectively. No local recurrence or lymph node metastasis was detected during post-ESD surveillance （15 -51 months）. Conclusion High grade intraepithelial neoplasia and early cancer of remnant stomach after partial gastreetomy might be indication for ESD because of its safety and definite effect. Additionally, careful man- agement of the fibre tissue is the key to procedure success.