内镜黏膜下剥离术治疗早期胃癌的疗效及术后复发相关危险因素分析

摘要/Abstract

摘要： 目的分析内镜黏膜下剥离术（ESD）治疗早期胃癌的疗效及术后复发相关危险因素,为ESD治疗早期胃癌提供依据。方法选取2017年1月—2019年1月聊城市人民医院收治的ESD治疗的200例早期胃癌患者作为研究对象,记录所有患者的性别、年龄、家族史、是否存在幽门螺杆菌感染、肿瘤大小、分化程度、病理类型、是否有转移、治疗情况、临床表现等。分析ESD治疗早期胃癌的疗效。随访3年,根据随访结果分为术后复发组及术后未复发组,比较两组患者的基本情况及临床资料,Logistic回归分析术后复发相关危险因素。结果本研究随访时间为 10~36个月,截止 2022年 1 月 30 日,平均随访时间为（30.35±5.01）个月,无死亡病例。患者复发情况：200例 ESD 治疗的早期胃癌患者共26 例复发,复发率13.0%。所有复发患者均再次行ESD,均获得长期生存。通过对ESD 治疗的早期胃癌患者术后复发的单因素及多因素分析发现：肿瘤大小（OR：3.981,95% CI：1.077~2.991）、浸润深度（OR：2.945,95% CI：1.946~4.997）、组织学分型（OR：2.909,95% CI：1.964~6.964）是术后复发的独立危险因素。结论 ESD治疗早期胃癌的临床疗效好,肿瘤大小、浸润深度、组织学分型是术后复发的独立危险因素。

关键词: 内镜黏膜下剥离术, 早期胃癌, 疗效, 术后复发, 危险因素

Abstract: Objective To analyze the efficacy of endoscopic submucosal dissection in the treatment of early gastric cancer and the risk factors related to postoperative recurrence, so as to provide evidence for ESD treatment of early gastric cancer. Methods 200 cases of early gastric cancer treated with ESD in Liaocheng People's Hospital from January 2017 to January 2019 were selected, and the gender, age, family history, presence of Helicobacter pylori infection, tumor size, differentiation, pathological type, metastasis, treatment and clinical manifestation of all patients were recorded. To analyze the efficacy of ESD in the treatment of early gastric cancer. After 3 years of follow-up, the patients were divided into two groups according to the follow-up. Results postoperative recurrence group and postoperative non-recurrence group. The basic situation and clinical data of patients in the two groups were compared, and the risk factors related to postoperative recurrence were analyzed by logistic regression. Results Survival of patients: The follow-up time of this study was 10~36 months. As of January 30,2022,the average follow-up time was (30.35 ± 5.01) months. There were no deaths. Recurrence of patients: 26 of 200 patients with early gastric cancer treated with ESD recurred, with a recurrence rate of 13.0%. All relapsed patients were treated with ESD again and achieved long-term survival. Through univariate and multivariate analysis of postoperative recurrence of early gastric cancer patients treated with ESD, it was found that tumor size (OR: 3.981, 95% CI: 1.077 ~ 2.991), depth of invasion (OR: 2.945, 95% CI: 1.946 ~ 4.997), histological classification (OR: 2.909, 95% CI: 1.964 ~ 6.964) were independent risk factors for postoperative recurrence. Conclusion ESD has a good clinical effect in the treatment of early gastric cancer.Tumor size, depth of invasion and histological classification are independent risk factors for postoperative recurrence.

Key words: endoscopic submucosal dissection, early gastric cancer, efficacy, postoperative recurrence, risk factors

中图分类号:

R735.2

席婷. 内镜黏膜下剥离术治疗早期胃癌的疗效及术后复发相关危险因素分析[J]. 中华养生保健, 2023, 41(13): 175-178.

XI Ting. The Effect of Endoscopic Submucosal Dissection in the Treatment of Early Gastric Cancer and the Risk Factors Related to Postoperative Recurrence[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(13): 175-178.

参考文献

[1] 胡祥. 第6版日本《胃癌治疗指南》拔萃[J].中国实用外科杂志,2021,41(10):1130-1141.
[2] 李艳. 早期胃癌行内镜黏膜下剥离术后复发的相关因素分析[J].中国实用医刊,2022,49(16):30-33.
[3] 霍江波,牛应林,于淑霞,等.内镜黏膜下剥离术在早期胃癌患者中的长期疗效研究[J].中国内镜杂志,2022,28(8):54-58.
[4] 周璇,李洪,冯志杰,等.内镜黏膜下剥离术治疗早期胃癌非治愈性切除相关危险因素分析[J].河北医科大学学报,2022,43(7):787-791.
[5] 中华医学会肿瘤学分会,中华医学会杂志社.中华医学会胃癌临床诊疗指南(2021版)[J].中华医学杂志,2022,102(16):1169-1189.
[6] 赫捷,陈万青,李兆申,等.中国胃癌筛查与早诊早治指南(2022,北京)[J].中国肿瘤,2022,31(7):488-527.
[7] 王剑舒,毛涛,李晓宇,等.早期胃癌患者98例经内镜黏膜下剥离术eCuraC-2级切除后的临床结局[J].中华消化杂志,2022,42(6):402-405.
[8] 陈俊良,王风华.2021版CSCO胃癌诊疗指南转移性胃癌更新解读[J].中国肿瘤临床,2022,49(7):325-330.
[9] 吴邓中. 内镜黏膜下剥离术对比外科手术治疗早期胃癌疗效的荟萃分析[D].南昌:南昌大学,2022.
[10] 高荣建. 内镜黏膜下剥离术治疗胃黏膜病变者的临床总结及病理升级的相关因素分析[D].延安大学,2022.
[11] 赵祥禄,管鑫,陈融,等.早期胃癌内镜黏膜下剥离术后出血危险因素的Meta分析[J].中国内镜杂志,2022,28(3):50-57.
[12] 习晓丽,叶美玲,王禾.内镜黏膜下剥离术治疗早期胃癌术后复发相关危险因素分析[J].现代肿瘤医学,2022,30(7):1264-1268.
[13] 王慕蕴,李智,卢先枝,等.内镜下黏膜剥离术与常规外科肿瘤切除术对早期胃癌患者术中肿瘤切除率、术后复发率的影响[J].实用癌症杂志,2022,37(10):1653-1656.
[14] 苏红鸽. 消化内镜黏膜下剥离术治疗早期胃癌的效果及安全性[J].临床医学,2022,42(2):27-29.
[15] PENG L J, et al.Outcome of endoscopic submucosal dissection for early gastric cancer of conventional and expanded indications: Systematic review and meta-analysis[J]. Journal of Digestive Diseases,2015,16(2):67-74.
[16] 宋顺喆,杨芳,宫爱霞,等.早期胃癌ESD术后发生同时性与异时性胃癌的危险因素分析[J].中华肿瘤防治杂志,2022,29(3):203-207,212.
[17] KIM S G, PARK C M, LEE N R, et al.Long-term clinical outcomes of endoscopic submucosal dissection in patients withn early gastric cancer: a prospective multicenter cohort study[J]. Gut Liver,2018,12(4):402-410.
[18] 吉栋德,段旭红,荣光宏,等.内镜黏膜下剥离术治疗早期胃癌术后复发的相关因素分析[J].中国内镜杂志,2022,28(1):66-71.
[19] 焦琳,周清文.内镜下黏膜剥离术治疗早期胃癌的疗效观察[J].中国肿瘤临床与康复,2021,28(12):1448-1452.
[20] 璩辉,丁云,夏超.内镜黏膜下剥离术治疗不同浸润深度早期胃癌的疗效及预后的影响[J].河北医学,2022,28(6):918-924.
[21] 中华人民共和国国家卫生健康委员会医政医管局.胃癌诊疗指南(2022年版)[J].中华消化外科杂志,2022,21(9):1137-1164.