中国实用外科杂志

中国实用外科杂志

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早期胃癌内镜治疗后追加外科手术病例特点、适应证和术式选择

李子禹，王胤奎   

  1. 北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心  恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142
  • 出版日期:2019-05-01 发布日期:2019-05-06

  • Online:2019-05-01 Published:2019-05-06

摘要：

内镜治疗技术的发展进一步推动了早期胃癌的微创治疗。然而，随之而来的问题是，部分接受内镜治疗的病人会出现非治愈性切除。早期胃癌内镜治疗后非治愈性病人的后续处理原则值得进一步关注。结合欧洲肿瘤内科学会（ESMO）、美国国家综合癌症网络（NCCN）及日本胃癌学会等国际指南及相关临床研究并回顾分析单中心数据后可得出结论，eCura-C的病人具有相对较高的癌残留风险，在与病人充分沟通后可考虑追加手术，但仍有较高的术后病理学无癌残留的风险。术式选择和切除范围可参考早期胃癌相关规定。如何准确预测非治愈性病人的淋巴结转移仍是未来的重点。前哨淋巴结活检及腹腔镜内镜联合手术是未来的发展方向。

关键词: 早期胃癌, 内镜治疗, 非治愈性切除, 补救手术

Abstract:

Endoscopic resection and salvage surgery for early gastric cancer　　LI Zi-yu, WANG Yin-kui.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)；Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author: LI Zi-yu, E-mail: ziyu_li@hsc.pku.edu.cn
Abstract　Endoscopic resection (ER) is playing an increasingly important role in treatment of gastric cancer. However, many patients received endoscopic resection turned out to be non-curative. Thus, the following treatment after ER is worthy of discussion. Reviewing the recomandations of guidelines published by European Society for Medical Oncology(ESMO), National Comprehensive Cancer Network(NCCN) and Japanese Gastric Cancer Association(JGCA) and relevant articles, and also retrospectively analysis of cases in our center.  In conclusion, for patients of eCura-C, surgery is recommended after considering relevant risks. Gastrectomy type and lymph node dissection range may refer to those for early gastric cancer. Further research is needed to predict lymph node metastasis more accurately. With the development of minimal invasive surgery, sentinel node navigation surgery and laparoscopic and endoscopic cooperative surgery will gain more and more attention.

Key words: early gastric cancer, endoscopic therapy, non-curative resection, salvage surgery