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内镜黏膜下剥离术治疗早期残胃上的癌的短期疗效分析

Short-term efficacy of endoscopic submucosal dissection for early carcinoma in the remnant stomach: a clinical analysis

    摘要
  • 摘要:
    目的  探讨内镜下黏膜剥离术治疗早期残胃上的癌的短期疗效。
    方法  回顾性选择2014年12月至2024年4月复旦大学附属中山医院内镜中心收治的因残胃上的早癌行内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）患者45例，共45个病灶，根据肿瘤发病位置分为吻合口组（n=15）和非吻合口组（n=30），比较两组的临床资料、内镜诊疗及病理组织学情况。
    结果  45个病灶均呈发红糜烂；吻合口组和非吻合口组黏膜下注射抬举不良分别为9例和2例，差异有统计学意义（P＜0.05）；行ESD手术分别切除病灶13个和28个，手术时间为80.00(50.00，100.00)min和55.00(43.75，80.00)min，两组手术时间差异有统计学意义（P=0.03）。45例患者中ESD手术达治愈性切除35例，其中吻合口组11例，非吻合口组24例，差异无统计学意义。
    结论  早期残胃上的癌术前需仔细观察、充分评估，避免遗漏，位于吻合口及缝线处的病变容易出现非整块切除。ESD是一项安全、有效的手术治疗方式，必要时可辅助牵引切除。

     

    Abstract:
    Objective To explore the short-term efficacy of endoscopic mucosal dissection in the treatment of early carcinoma in the remnant stomach.
    Methods  A retrospective study was conducted on 45 patients with early residual gastric cancer who underwent endoscopic submucosal dissection (ESD) at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2014 to April 2024, with a total of 45 lesions. The patients were divided into an anastomotic group (n=15) and a non anastomotic group (n=30) based on the location of tumor occurrence, and their clinical data, endoscopic diagnosis and treatment, and histopathological conditions were compared between the two groups.
    Results  All 45 patients had lesions with redness and erosion. There were 9 cases of poor lifting of submucosal injection in the anastomotic group and 2 cases in the non anastomotic group, respectively, and the difference was statistically significant (P<0.05). ESD surgery was performed on 13 lesions in the anastomotic group and 28 lesions in the non anastomotic group, with surgery times of 80.00 (50.00, 100.00) minutes and 55.00 (43.75, 80.00) minutes, respectively. The difference in surgery time between the two groups was statistically significant (P=0.03). Among the 45 patients, ESD surgery achieved curative resection in 35 cases, including 11 cases in the anastomotic group and 24 cases in the non anastomotic group, with no statistically significant difference.
    Conclusion  Careful preoperative evaluation of early carcinoma in the remnant stomach is essential to prevent oversight. Lesions at anastomotic sites and suture lines present higher technical challenges for complete resection. ESD demonstrates safety and efficacy, with auxiliary traction techniques available when necessary.

     

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