早期胃癌内镜治疗抉择与补救手术

Strategy of endoscopic resection for early gastric cancer and salvage surgery

我国早期胃癌检出率呈现逐年上升的趋势,基于循证医学证据的内镜治疗已成为早期胃癌的主要手段之一。根据内镜诊断、影像学诊断及病理学评估来选择适合内镜切除的早期胃癌,但是内镜切除存在手术风险和相应的并发症,包括胃穿孔、出血及肿瘤残留等。因此,需要严格遵循早期胃癌内镜切除的手术适应证,掌握内镜切除技术,选择合理的内镜切除策略,并制定内镜切除后肿瘤残留补救手术方案,将提高早期胃癌治愈率及手术安全性。笔者查阅相关研究,系统阐述早期胃癌内镜治疗抉择与补救手术。

The detection rate of early gastric cancer in China shows an increasing trend year by year,and endoscopic treatment based on evidence-based medicine has become one of the major modalities for early gastric cancer.Endoscopic diagnosis,imaging diagnosis and pathological evaluation are applied to evaluate early gastric cancer which is suitable for endoscopic resection.However,endoscopic resection has surgical risks and relevant complications,including gastric perforation,hemorrhage,and tumor residuals.Therefore,it is necessary to strictly follow the surgical indications of endoscopic resection for early gastric cancer,master the endoscopic resection technique,choose a reasonable strategy of endoscopic resection,and draw up a protocol of salvage surgery for tumor residue after endoscopic resection,which will improve the curability and surgical safety for early gastric cancer.The authors consult relevant research and systematically elaborate on the strategy of endoscopic resection for early gastric cancer and salvage surgery.