文章摘要
倪 永,沙林玉,李培培,宋雪梅,于莲珍.早期胃癌治疗方式的选择[J].南京医科大学学报,2020,(9):1325~1330
早期胃癌治疗方式的选择
Selection of treatment for early gastric cancer
投稿时间:2019-10-08  
DOI:10.7655/NYDXBNS20200914
中文关键词: 早期胃癌  内镜黏膜下剥离术  外科手术  淋巴结转移  前瞻性观察研究
英文关键词: early gastric cancer  endoscopic submucosal dissection  surgical operation  lymph node metastasis  prospective study
基金项目:国家高技术研究发展计划(863计划)
作者单位
倪 永 南京医科大学第一附属医院消化科江苏 南京 210029 
沙林玉 南京医科大学第一附属医院消化科江苏 南京 210029 
李培培 南京医科大学第一附属医院消化科江苏 南京 210029 
宋雪梅 南京医科大学第一附属医院消化科江苏 南京 210029 
于莲珍 南京医科大学第一附属医院消化科江苏 南京 210029 
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中文摘要:
      目的:比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与外科手术治疗早期胃癌(early gastric cancer,EGC)患者的临床病理特征,探讨ESD治疗EGC的绝对适应证及扩大适应证,为EGC选择最佳治疗方案提供依据。方法:前瞻性观察2017 年 1 月—2018 年 8 月南京医科大学第一附属医院收治的495例EGC患者,其中ESD治疗163例(ESD组),同期行外科手术治疗332例(外科组)。其中,ESD组153例(观察组)、外科组183例(对照组)符合ESD标准,分析两者临床选择的差异。并单独分析外科手术标本的淋巴结转移情况。结果:①观察组和对照组经多因素分析,结果显示术前病理癌变、平坦型、有溃疡和黏膜下层浸润为选择外科手术的影响因素(OR=25.970、3.970、7.244、5.038,P < 0.05)。②ESD组中,适应证选择的准确率为93.87%(153/163)。10例不符合ESD适应证的病灶均为未分化型。③多因素分析显示,病灶位置、大小、浸润深度及淋巴脉管浸润为EGC淋巴结转移的独立危险因素(OR=4.433、2.097、3.510、43.701,P < 0.05)。④外科组中符合ESD绝对适应证、扩大适应证的淋巴结转移率分别为1.96%、3.79%,二者差异无统计学意义(F=0.428,P=0.51)。结论:一部分符合ESD扩大适应证的患者选择了外科手术,其中部分患者可行ESD,未分化型患者选择ESD的治疗准确率及治愈性切除率较低。胃中部、>2 cm、黏膜下层浸润及有淋巴脉管浸润为EGC淋巴结转移的独立危险因素。
英文摘要:
      Objective:This study aims to compare the difference of clinicopathological characteristics of endoscopic submucosal dissection(ESD) and surgery of early gastric cancer(EGC) patients,and to explore the difference of the absolute and expanded criteria for ESD,so as to provide a basis for choosing the best treatment for EGC. Methods:The clinicopathological data of 495 EGC lesions in the First Affiliated Hospital of Nanjing Medical University were prospectively observed,of which 163 patients treated with ESD,and 332 patients treated with surgery. Univariate and multivariate analyses were performed on 153 patients(observation group)in the ESD group and 183 patients(control group)in the surgical group who met the endoscopic resection criteria. Finally,the lymph node metastasis of surgical group was analyzed separately. Results:①Multivariate analysis showed that endoscopic forceps biopsy with carcinoma,flat type,ulcer,and submucosal invasion were influence factors for the selection of surgery(OR=25.970,3.970,7.244,5.038,P < 0.05). ② In the ESD group,the overall accuracy of indication selection was 93.87%(153/163). The pathology of 10 lesions met the surgical criteria were undifferentiated. ③Multivariate analysis showed that tumor location,tumor size,depth of invasion,and lymphovascular invasion were independent risk factors for lymph node metastasis(OR=4.433,2.097,3.510,43.701,P < 0.05).④In the surgical group,the lymph node metastasis rate of of patients suitable for absolute criteria and expanded criteria of ESD were1. 96% and 3.79%,respectively. There were no statistically significant differences in lymph node metastasis rate between patients met absolute criteria and expanded criteria(F=0.428,P=0.51). Conclusion:Some of patients who met the extended indications of ESD chose surgery,and some of them could use ESD. The treatment accuracy and curative resection rate of undifferentiated patients were low. The tumor located in the middle?third of the stomach,the tumor size>2 cm,submucosal invasion and lymphovascular invasion were independent risk factors for lymph node metastasis.
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