内镜黏膜下剥离术治疗早期胃癌及癌前病变疗效及出血危险因素分析

Curative effect and bleeding risk factors of endoscopic submucosal dissection in the treatment of early gastric cancer and precancerous lesions

目的内镜微创治疗已成为早期胃癌及癌前病变治疗的重要方式。本研究分析内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌及癌前病变的有效性及并发症危险因素。方法回顾性分析临沂市肿瘤医院2013-01-01—2015-12-31行ESD治疗的61例早期胃癌及癌前病变患者临床资料,观察其治疗效果及并发症,采用二元Logistic逐步回归方法分析并发症危险因素。结果61例患者均顺利完成内镜下治疗,手术平均操作时间(78.9±11.5)min,整块切除率和治愈性切除率分别为100.00%和91.80%。主要并发症为出血,共11例,无穿孔病例发生。Logistic逐步回归分析显示,病变部位(贲门-胃底部)、病理类型(早期胃癌)为ESD并发出血相关危险因素(OR=53.428,95%CI:3.191~1 000.543,P=0.005;OR=13.765,95%CI:1.216~241.139,P=0.029)。治疗结束随访6~36个月,平均随访时间(25.6±2.1)个月,2例复发后再行ESD治疗,治疗后再次随访,未再发现复发转移病例。结论ESD是治疗早期胃癌及癌前病变安全、有效的方法,贲门-胃底病变和早期胃癌治疗时更容易发生出血。

OBJECTIVE Minimally invasive therapeutic endoscopy has become one of the most important methods for the treatment of early gastric cancer and precancerous lesions.This study was to analyze the effectiveness of endoscopic submucosal dissection（ESD）in the treatment of early gastric cancer and precancerous lesions and the risk factors for complications.METHODS The clinical data of 61 patients with early gastric cancer and precancerous lesions treated by ESD during the period of 2013-12-01-2015-12-31 from Linyi Tumour Hospital was analyzed to observe the therapeutic effect and complications,and analyze the risk factors for complications.RESULTS Endoscopic treatment was successfully completed in all 61 patients,the average operation time was（78.9±11.5）min,the en bloc resection rate and curative resection rate were 100.00% and 91.80%.The main complication was bleeding,which occurred in 11 cases,and no perforation occurred.Logistic regression analysis showed that the diseased region（cardiac and gastric fundus）and pathologic category（early cancer）were the risk factor of bleeding associated with ESD（OR=53.428,95%CI=3.191-1 000.543,P=0.005;OR=13.765,95%CI=1.216-241.139,P=0.029）.They were followed up from 6 to 36 months with an average of（25.6±2.1）months after treatment,two cases underwent ESD for a recurrence,then no further recurrence or metastasis was found.CONCLUSION ESD is an effective and safe procedure in treatment of early gastric cancer and precancerous lesions,the bleeding is more likely to occur during the treatment of the cardiac region,gastric fundus region and in early gastric cancer.