目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法选择淳化县医院消化内科2013年1月至2014年2月收治的EGC及癌前病变患者120例为观察组,给予ESD治疗,选择同期进行外科传统手术的EGC及癌前病变患者120例为对照...目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法选择淳化县医院消化内科2013年1月至2014年2月收治的EGC及癌前病变患者120例为观察组,给予ESD治疗,选择同期进行外科传统手术的EGC及癌前病变患者120例为对照组,比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间、手术疗效、术后6个月复发或转移、术后3年存活率、术后并发症,疼痛程度评分(VAS)。结果观察组和对照组患者的手术时间[(90.4±7.8) min vs (128.9±8.8) min]、术中出血量[(92.1±9.1) mL vs (167.9±8.2) m L]、住院时间[(8.9±1.2) d vs (16.1±2.1) d]、肛门排气时间[(10.2±0.8) h vs (19.2±1.9) h]、VAS评分[(3.1±0.9)分vs (6.1±1.8)分]比较,观察组均明显少于对照组,差异均具有统计学意义(P<0.05);观察组患者术后6个月复发率、转移率和3年存活率分别为2.5%、1.7%、97.5%,分别与对照组的1.7%、3.4%、98.3%比较差异均无统计学意义(P>0.05);观察组患者的肿瘤完整切除率为98.3%,与对照组的99.2%比较差异无统计学意义(P>0.05);观察组患者的并发症发生率为5.8%,明显低于对照组的24.2%,差异具有统计学意义(P<0.05)。结论 ESD治疗EGC及癌前病变疗效理想,手术创伤小,患者恢复快,术后并发症少。展开更多
AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastre...AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated(pure D), pure undifferentiated(pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTS Of the 298 patients, 165(55.4%) had mucosa-confined EGC and 133(44.6%) had submucosa-invasive EGC. Only 13(7.9%) cases of mucosa-confined EGC and 30(22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion(OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type(OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixedtype(OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixedtype group(P = 0.012) and pure U group(P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group(P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixedtype(P = 0.012) and pure U group(P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group(P = 0.375). Multivariate logistic analysis showed that only female sex(OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion(OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC(P = 0.106).CONCLUSION for mucosal EGC, histological mixed-type is not an展开更多
文摘目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法选择淳化县医院消化内科2013年1月至2014年2月收治的EGC及癌前病变患者120例为观察组,给予ESD治疗,选择同期进行外科传统手术的EGC及癌前病变患者120例为对照组,比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间、手术疗效、术后6个月复发或转移、术后3年存活率、术后并发症,疼痛程度评分(VAS)。结果观察组和对照组患者的手术时间[(90.4±7.8) min vs (128.9±8.8) min]、术中出血量[(92.1±9.1) mL vs (167.9±8.2) m L]、住院时间[(8.9±1.2) d vs (16.1±2.1) d]、肛门排气时间[(10.2±0.8) h vs (19.2±1.9) h]、VAS评分[(3.1±0.9)分vs (6.1±1.8)分]比较,观察组均明显少于对照组,差异均具有统计学意义(P<0.05);观察组患者术后6个月复发率、转移率和3年存活率分别为2.5%、1.7%、97.5%,分别与对照组的1.7%、3.4%、98.3%比较差异均无统计学意义(P>0.05);观察组患者的肿瘤完整切除率为98.3%,与对照组的99.2%比较差异无统计学意义(P>0.05);观察组患者的并发症发生率为5.8%,明显低于对照组的24.2%,差异具有统计学意义(P<0.05)。结论 ESD治疗EGC及癌前病变疗效理想,手术创伤小,患者恢复快,术后并发症少。
基金Supported by Medical Science and Technology Development Foundation of Nanjing Department of Health,No.201402032
文摘AIM To investigate the relationship between histological mixed-type of early gastric cancer(EGC) in the mucosa and submucosa and lymph node metastasis(LNM).METHODS This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated(pure D), pure undifferentiated(pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.RESULTS Of the 298 patients, 165(55.4%) had mucosa-confined EGC and 133(44.6%) had submucosa-invasive EGC. Only 13(7.9%) cases of mucosa-confined EGC and 30(22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion(OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type(OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixedtype(OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixedtype group(P = 0.012) and pure U group(P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group(P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixedtype(P = 0.012) and pure U group(P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group(P = 0.375). Multivariate logistic analysis showed that only female sex(OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion(OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC(P = 0.106).CONCLUSION for mucosal EGC, histological mixed-type is not an
