早期胃癌内镜黏膜下剥离术后追加手术的原因分析

Analysis of Reasons for Additional Surgery After Endoscopic Submucosal Dissection for Early Gastric Cancer

目的探讨早期胃癌内镜黏膜下剥离(endoscopic submucosal dissection,ESD)术后追加外科手术的原因。方法回顾性分析2015年1月~2019年8月ESD术后追加手术的23例早期胃癌共25处病灶的临床病理资料,包括内镜下表现、ESD病理结果及手术病理结果。结果早期胃癌ESD术后追加手术的原因有病灶侵犯黏膜下层19处(76%),分化类型差16处(64%),脉管内瘤栓8处(32%),阳性切缘9处(36%)。追加外科手术后病理提示肿瘤残留2例,淋巴结转移1例。随访2~53个月,中位数17个月,无复发及死亡。结论侵犯黏膜下层、分化类型差、脉管内侵犯以及基底切缘阳性是早期胃癌ESD术后追加手术的主要原因。

Objective To analyze the reasons for additional surgery after endoscopic submucosal dissection(ESD)for early gastric cancer.Methods The clinicopathological data of 25 lesions in 23 patients with early gastric cancer who underwent additional surgery after ESD in our hospital from January 2015 to August 2019 were analyzed retrospectively.Endoscopic findings,ESD pathological results and surgical pathological results were recorded.Results The reasons of additional surgery for early gastric cancer after ESD included invasion of submucosa in 19 lesions(76%),poor differentiation in 16 lesions(64%),intravascular tumor thrombus in 8 lesions(32%),and positive margin in 9 lesions(36%).After additional surgery,tumor residue was found in 2 cases and lymph node metastasis in 1 case.Follow-up time was 2-53 months,with a median of 17 months.No recurrence or death was found during the follow-up period.Conclusion Poor differentiation,invasion of submucosa,intravascular invasion and positive basal incision margin were the main reasons for additional operation after ESD in early gastric cancer.