中国实用外科杂志

中国实用外科杂志

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早期胃癌行内镜黏膜下剥离术非治愈性切除后追加外科手术时机选择研究

王    萌a，刘    颂a，张    松b，郑黎明a，凌亭生b，管文贤a   

  1. 南京大学医学院附属鼓楼医院   a.普通外科   b.消化科， 江苏南京210008
  • 出版日期:2021-01-01 发布日期:2021-01-22

  • Online:2021-01-01 Published:2021-01-22

摘要： 目的    探讨早期胃癌行内镜黏膜下剥离术（ESD）非治愈性切除后追加外科手术的时机。方法    回顾性分析2011年3月至2017年3月于南京大学医学院附属鼓楼医院诊断早期胃癌行ESD非治愈性切除后90 d内追加外科根治手术90例，排除失访7例，最终纳入83例。根据追加外科手术的时间分为早期手术组（ESD后≤29 d，52例）和延迟手术组（ESD后30~90 d，31例）。比较两组病人术中出血量、手术时间、术后并发症、术后住院时间、淋巴结阳性率、胃病灶阳性率、复发率、总体存活率和无病存活率。进一步分析ESD非治愈性切除病人淋巴转移的危险因素。结果    两组病人一般资料比较，差异无统计学意义。中位随访时间64个月，两组的3年无病生存率差异无统计学意义（96.2% vs. 96.8%，P=0.884）。与早期手术组相比，延迟手术组的术中出血量减少（P=0.011）。两组的手术时间、术后住院时间、术后并发症发生率差异无统计学意义。延迟手术组的淋巴结转移率（12.9%） 高于早期手术组（5.8%），但两者比较差异无统计学意义（P=0.258）。脉管癌栓是淋巴转移的独立危险因素（OR=5.956，95%CI：0.017-0.641，P=0.015）。结论    早期胃癌ESD非治愈性切除后，延迟手术组相比早期手术组的术中出血量减少，生存预后差异无统计学意义。有脉管癌栓危险因素，根据病人的情况建议适当缩短手术等待时间。

关键词: 早期胃癌, 内镜黏膜下剥离术, 非治愈性切除, 追加手术

Abstract: Study of the optimal timing interval between additional surgery and non-curative endoscopic resection for early gastric cancer        WANG Meng*, LIU Song , ZHANG Song , et al. *Department of General Surgery, Nanjing Drum Tower Hospital,Nanjing210008,China
Corresponding authors： LING Ting-sheng , E-mail:chinalts@126.com ; GUAN Wen-xian ,E-mail:guan_wx@163.com
WANG Meng and LIU Song are the first authors who contributed equally to the article
Abstract    Objective    To investigate the optimal timing interval between additional surgery and endoscopic resection. Methods    We retrospectively reviewed all the early gastric cancer cases who accepted additional surgery after non-curative endoscopic resection within 90 days. Total 83 cases were included(7 patients failing to follow up were excluded). They were divided into two groups: early surgery group (timing interval <30 days, n=52) and later surgery group (timing interval 30-90 days, n=31). We evaluated the clinicopathological characteristics, surgical and oncological outcomes. Further, we analyzed the risk factors of lymph node metastasis. Results    There were no significant differences in clinicopathological characteristics between two groups. The median follow up time was 64 months. Compared with early surgery group, the later surgery group had less intraoperative blood loss (P=0.011). There were no significant differences in operative time, hospital time after operation, comorbidity, and 3 year disease free survival (96.2% vs. 96.8%，P=0.884). The positive rate of lymph node metastasis in later surgery group (12.9%) was higher than that in early group(5.8%). However, there was no significant difference(P=0.258).The independent risk factor of lymph node metastasis was lymphovascular invasion. Conclusion    Compared with early surgery group, the later surgery group had less intraoperative blood loss. For those cases with lymphovascular invasion, we suggest less waiting time for additional surgery.

Key words: early gastric cancer, endoscopic submucosal dissection, non-curative resection, additional surgery