摘要
目的了解内镜黏膜下剥离术(ESD)治疗早期胃癌及癌前病变术后标本切缘阳性危险因素。方法回顾性分析280例ESD治疗早期胃癌及癌前病变患者临床资料,采用多因素logistic回归分析ESD术后标本切缘阳性的危险因素,Kaplan-Meier生存分析法分析不同标本切缘结果患者病灶复发率。结果 280例患者中,ESD术后病理标本切缘阳性21例,其中基底切缘阳性9例,侧切缘阳性7例,切缘阳性合并基底切缘阳性5例,切缘阳性发生率为7.50%。logistic回归分析结果显示,与病变部位为下段、浸润深度为上皮内层相比,胃上段病变(OR=2.568,95%CI:3.678~5.342)、浸润深度为黏膜肌层(OR=6.122,95%CI:1.128~16.845)和黏膜下层浅层(OR=5.558,95%CI:2.451~6.874)发生切缘阳性危险性更高,有溃疡(OR=2.635,95%CI:1.698~3.456)发生切缘阳性危险性更高(P值均<0.05)。切缘阳性患者复发率为42.85%,显著高于切缘阴性者的11.58%(χ2=15.848,P<0.001)。结论早期胃癌和癌前病变术后标本切缘阳性与病变部位、是否有溃疡、浸润深度有关。
Objective To analyze the risk factors for positive resection margins after endoscopic submucosal dissection(ESD)for early gastric cancer and precancerous lesion.Methods The clinical data of 280 patients with early gastric cancer or precancerous lesion treated with ESD in our hospital were retrospectively analyzed.Multivariate logistic regressional analysis were used to assess of risk factors influencing ESD postoperative specimen excision margin.Kaplan-meier survival analysis was performed to analyze the recurrence rate of lesions in patients with different specimen resection results.Results Among 280 patients,21 cases were positive resection margins after ESD surgery,among whom 9 were positive in basal margin,7 were positive in lateral resection margin,5 were positive marginal resection margin combined with positive basal resection margin,resulting the overall positive resection margin incidence of 7.5%.The logistic regression analysis showed that compared with the lower part of the lesion and the inner layer of the epithelium for invasion depth,the upper part of the stomach(OR=2.568,95% CI:3.678-5.342),the muscular layer of the mucosa(OR=6.122,95%CI:1.128-16.845)and the superficial layer of the submucosa(OR=5.558,95%CI:2.451-6.874)were more likely to show positive cutting edge,patients with ulcers(OR=2.635,95% CI:1.698-3.456)had even higher risk(all P<0.05).The recurrence rate of patients with positive margin was 42.85%,which was significantly higher than that of patients with negative margin,which was 11.58% (χ~2=15.848,P<0.001).Conclusion The positive margin of early gastric cancer and precancerous lesions is related to the lesion site,ulcer and depth of invasion.
作者
张艳
张伟
张莹
ZHANG Yan;ZHANG Wei;ZHANG Ying(Xiamen University Xiang'an Hospital,Fujian Xiamen 361005,China;不详)
出处
《江苏预防医学》
CAS
2020年第5期516-519,共4页
Jiangsu Journal of Preventive Medicine
关键词
内镜黏膜下剥离术
早期胃癌
癌前病变
切缘阳性
危险因素
Endoscopic submucosal dissection
Early gastric cancer
Precancerous lesions
Positive resection margin
Risk factors
