CAJ | 학술논문

目的探讨术前评估早期胃癌(EGC)内镜黏膜下剥离术(ESD)完全性切除影响因素的必要性,为指导EGC治疗方案的选择提供依据.方法前瞻性对66例EGC患者的病灶大小、是否合并溃疡、分化程度、浸润深度及病灶边界进行术前内镜评估,并与术后病理结果对比,分析EGC行ESD完全性切除的影响因素.结果高级别上皮内瘤变组和黏膜内癌组病灶以≤30 mm为主(90.9％和88.5％),黏膜下癌组病灶以＞30 mm为主(57.1％),3组比较差异有统计学意义(x2=11.930,P＜0.005).14例EGC合并溃疡,均未突破黏膜肌层,ESD术后病理底切缘及边切缘均未见癌侵犯,手术后病理均未见标本切端肿瘤细胞浸润及淋巴结癌转移.45例行ESD治疗的EGC,病灶边界经白光结合色素内镜确定低估率高于ME-NBI(15.6％比2.2％,P＜0.05).33例黏膜内癌和黏膜下癌利用白光内镜判断分化程度正确率为93.9％(31/33),经ME-NBI无法进行分化程度判断.结合白光内镜和ME-NBI判断浸润深度时,高级别上皮内瘤变组判断正确率为84.8％ (28/33),黏膜内癌组判断正确率为57.7％(15/26),黏膜下癌组判断正确率为71.4％ (5/7),高级别上皮内瘤变组与黏膜内癌组比较差异有统计学意义(x2 =5.426,P＜0.05).结论病灶大小＞30mm、合并溃疡、未分化以及深层次浸润可能皆为ESD不完全切除的危险因素,术前应严格把握,并且治疗过程中需确定病灶的真实边界,以免不必要的手术.
목적 탐토술전평고조기위암(EGC)내경점막하박리술(ESD)완전성절제영향인소적필요성,위지도EGC치료방안적선택제공의거.방법 전첨성대66례EGC환자적병조대소、시부합병궤양、분화정도、침윤심도급병조변계진행술전내경평고,병여술후병리결과대비,분석EGC행ESD완전성절제적영향인소.결과 고급별상피내류변조화점막내암조병조이≤30 mm위주(90.9％화88.5％),점막하암조병조이＞30 mm위주(57.1％),3조비교차이유통계학의의(x2=11.930,P＜0.005).14례EGC합병궤양,균미돌파점막기층,ESD술후병리저절연급변절연균미견암침범,수술후병리균미견표본절단종류세포침윤급림파결암전이.45례행ESD치료적EGC,병조변계경백광결합색소내경학정저고솔고우ME-NBI(15.6％비2.2％,P＜0.05).33례점막내암화점막하암이용백광내경판단분화정도정학솔위93.9％(31/33),경ME-NBI무법진행분화정도판단.결합백광내경화ME-NBI판단침윤심도시,고급별상피내류변조판단정학솔위84.8％ (28/33),점막내암조판단정학솔위57.7％(15/26),점막하암조판단정학솔위71.4％ (5/7),고급별상피내류변조여점막내암조비교차이유통계학의의(x2 =5.426,P＜0.05).결론 병조대소＞30mm、합병궤양、미분화이급심층차침윤가능개위ESD불완전절제적위험인소,술전응엄격파악,병차치료과정중수학정병조적진실변계,이면불필요적수술.
Objective To prospectively evaluate the risk factors of complete resection in early gastric cancer (EGC) with endoscopic submucosal dissection (ESD),and to guide the choice of treatment methods.Methods This study prospectively evaluated the endoscopic features of 66 EGCs,including the lesion size,presence or absence of ulceration,the extent of differentiation,invasion depth and entire margins of the EGC,then compared them with postoperative pathologic results and analysed these factors.Results The lesion size of the high grade intmepithelial neoplasia (H) group and the intramucosal carcinoma (M) group were mainly less than 30 mm (90.9％ vs.88.5％),but 57.1％ of the submucosal carcinoma (SM) were more than 30 mm.There was a significant difference between any two of three groups (P ＜ 0.05).Fourteen EGCs who got ulceration without invasion beyond mucosal muscularis underwent ESD successfully,and the basal or dissected margin had no residual tumor cells confirmed pathologically.And no tumor cell infiltration or lymph node metastasis was discovered.Of 45 EGCs with ESD,the underestimation rate for horizontal extent determined by white light and chromoendoscopy was higher than that of magnifying endoscopy with narrow-band imaging (ME-NBI) (15.6％ vs.2.2％,P ＜0.05).Diagnostic accuracy for the extent of differenciation by conventional endoscopy was 93.9％ (31/32,P ＞ 0.1),but it's unable to determine the extent of differentiation by ME-NBI.The accuracy of the group H was 84.8％ (28/33),that of M was 57.7％ (15/26),that of SM was 71.4％ (5/7),and there was a significant difference between group H and group M (P ＜ 0.05).Conclusion To achieve complete resection of EGC with ESD,the lesion more than 30 mm,presence of ulceration,undifferentiated type,deep infiltration should be considered as the risk factors,and it's also important to identify the horizontal extent of EGC to avoid unnecessary operation.