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内镜黏膜下剥离术后追加胃切除术对早期胃癌患者预后的影响

Impact of additional gastrectomy after endoscopic submucosal dissection on the prognosis of early gastric cancer

摘要:

目的:探讨内镜黏膜下剥离术(ESD)后追加胃切除手术治疗是否对早期胃癌的预后有负面影响。方法回顾分析2008年1月至2014年12月间复旦大学附属中山医院内镜中心收治的经ESD治疗或胃切除手术治疗的107例早期胃癌患者临床资料,其中44例为ESD术后追加胃切除手术治疗者[ESD追加胃切除组,追加胃切除的原因为:切缘阳性10例,淋巴管或血管侵袭5例,高分化黏膜内癌其肿瘤>3 cm且有溃疡6例,低分化黏膜内癌期肿瘤>2 cm 4例,肿瘤侵犯黏膜下层(SM1)且病灶>3 cm 10例,肿瘤侵犯黏膜下层(SM2)9例],63例行单纯胃切除手术者(单纯胃切除组),比较两组患者术中、术后及预后情况。结果两组患者基线资料的比较,差异均无统计学意义(均P>0.05)。经过评估,ESD追加胃切除组绝对治疗适应证和相对治疗适应证分别有19例(43.2%)和25例(56.8%),单纯胃切除组则分别有28例(44.4%)和35例(55.6%),差异无统计学意义(P=0.897)。两组手术方式(P=0.164)、淋巴结清扫方式(P=0.330)、淋巴结清扫数目(P=0.467)、淋巴结转移率(P=0.690)、手术时间(P=0.932)、术后发热或感染的发生率(P=0.923)以及术后住院时间(P=0.687)的差异均无统计学意义。 ESD追加胃切除组和单纯胃切除组随访时间分别为(35.5±15.0)月和(29.5±18.1)月(P=0.072);两组复发率分别为4.5%(2/44)和9.5%(6/63)(P=0.229);3年无瘤生存率分别为95.5%和89.2%,两组差异无统计学意义(P=0.571)。结论 ESD后追加胃切除手术治疗对早期胃癌的预后无负面影响,疗效与单纯行胃切除手术治疗相似。

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abstracts:

Objective To investigate the impact of additional gastrectomy after endoscopic submucosal dissection (ESD) on the prognosis of early gastric cancer. Methods Clinical data of 107 early gastric cancer patients undergoing additional gastrectomy after ESD (research group, n=44) or radical surgery (control group, n=63) from January 2008 to December 2014 in Zhongshan Hospital were retrospectively analyzed. The reasons for additional gastrectomy after ESD included positive resection margin (n=10 ), lymphovascular invasion (n=5), well-differentiated mucosal tumor with a diameter >3 cm (n=10), poor-differentiated mucosal tumor with a diameter>2 cm (n=4), submucosal tumor(sm1) with a diameter>3 cm(n=10), and submucosal tumor(sm2) (n=9). Operation time, length of stay, lymph node metastasis, tumor recurrence and disease-free survival rate were compared between two groups. Results Baseline data of two groups were not significantly different (all P > 0.05). After evaluation, absolute and relative indications were identified in 19 cases (43.2%) and 25 cases (56.8%) of research group, and in 28 cases (44.4%) and 35 cases (55.6%) of control group without significant difference (P=0.897). Lymph node metastasis occurred in 6 patients (4.5%) after surgery in research group and 6.3% in control group (P=0.690). Operation time was (218.5 ± 74.3) minutes in research group and (219.8 ± 81.8) minutes in control group (P=0.932). Length of stay was (10.0 ± 12.3) days in research group and (10.8 ± 9.9) days in control group (P=0.687). Follow-up time was (35.5 ± 15.0) months in research group and (29.5 ± 18.1) months in control group (P = 0.072). Tumor recurrence rate was 4.5% in research group and 9.5% in control group (χ2= 0.928, P = 0.229). Mortality was 4.5% in research group and 7.9% in control group (χ2=0.487, P=0.485). Besides, no significant differences of operation mode(P=0.164), lymphatic clearance mode (P=0.330), number of harvested lymph node(P=0.467), morbidity of postoperative infection or fever (P=0.923) were found. Three-year tumor-free survival rate was 95.5% and 89.2% in research and control group respectively without significant differences (P = 0.571). Conclusion Additional gastrectomy after endoscopic submucosal dissection has no negative influence on the prognosis of patients with early gastric cancer , whose efficacy is similar to simple radical gastrectomy.

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作者: 朱俊宇 [1] 时强 [1] 周平红 [1] 陈天音 [1] 徐佳昕 [1] 刘靖正 [1] 姚礼庆 [1] 徐美东 [1] 张轶群 [1]
期刊: 《中华胃肠外科杂志》2016年19卷8期 912-916页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1671-0274.2016.08.023
发布时间: 2016-09-27
基金项目:
国家自然科学基金(81470811) 上海市科委重点医学项目(13411950801)Fund program National Natural Science Fund (81470811) The Key Medical Project of Science and Technology Commission of Shanghai Municipality
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