内镜黏膜下剥离术治疗胃黏膜病变术后复发相关因素分析

Risk factors of recurrence for gastric mucosal lesions after endoscopic submucosal dissection

目的探讨内镜黏膜下剥离术（ESD）治疗胃黏膜高级别上皮内瘤变（HGIN）及早期胃癌（EGC）术后复发情况及其相关危险因素。方法总结2006年11月至2016年1月在解放军总医院内镜中心行ESD且术后病理诊断为HGIN及EGC的444例患者（451处病变）的临床和随访资料，统计分析术后复发的相关因素。结果ESD术后共随访410例患者，随访期间13例患者（13处病变）复发，复发率为3．2％，平均复发时间（17．6±9．6）个月（6—38个月）。通过单因素和多因素分析，病变直径〉4．0cm（P=0．012，OR=10．855，95％CI：1．673～70．442）是ESD术后复发的独立危险因素。结论随着病变范围增大，ESD术后复发率增加，对于病变较大的患者应加强术后监测。

Objective To investigate the recurrence and risk factors of gastric high-grade intraepithelial neoplasia （HGIN） and early gastric cancer （EGC） after endoscopic submucosal dissection （ESD）. Methods The clinical and follow-up data on 444 patients （451 lesion） with HGIN and EGC undergoing ESD in Digestive Endoscopy Center of Chinese PLA General Hospital from November 2006 to January 2016 were summarized, and the risk factors of recurrence were analyzed. Results A total of 410 patients were followed-up, and the recurrence rate was 3.2% （13 patients, 13 lesions）, with mean recurrence time of 17. 6±9. 6 months （6-38 months）. Univariate and multivariate analysis revealed that the size of the lesion〉4.0 cm was the only risk factor of recurrence （ P = 0. 012, OR = 10. 855,95% CI： 1. 673 ~ 70. 442）. Conclusion The rate of recurrence is increasing with the EGC extending, therefore, postoperative monitoring should be strengthened to patients with larger lesion.