早期胃癌内镜治愈性切除的影响因素

目的分析影响早期胃癌内镜治愈性切除的危险因素，提高内镜治愈性切除早期胃癌的可能性。方法收集2008年10月至2013年3月行内镜切除治疗的早期胃癌（包括高级别上皮内瘤变）患者的临床资料；分析性别、年龄、病灶位置、病灶直径、病灶内镜形态学分型及伴有溃疡形成6个因素对内镜切除术（ER）整块切除及治愈性切除的影响；同时分析非治愈性切除的主要原因。结果纳入早期胃癌共94例包含94个病灶，其中高级别上皮内瘤变病灶20个，黏膜内癌病灶70个，黏膜下浅层浸润癌（距黏膜肌层500斗m以内）病灶4个。其中5个病灶经EMR切除，89个病灶经ESD切除。ER整块切除率为95．7％（90／94），治愈性切除率为79．8％（75／94）。直径〉3．0cm的病灶治愈性切除率显著低于直径≤2．0em的病灶（P=0．022，OR=0．108，95％C1：0．016—0．721），伴有溃疡形成的病灶治愈性切除率显著低于不伴有溃疡形成的病灶（P=0．047，OR=0．149，95％CI：0．023～0．971）。非治愈性切除的主要原因是侧缘肿瘤细胞的残留。结论病灶直径〉3．0cm、伴有溃疡形成是影响早期胃癌ER治愈性切除的危险因素。

Influencing factors contributing to curative resection of early gastric endoscopy

Objective To analyze risk factors contributing to curative resection of early gastric en- doscopy effects, and to increase the likelihood of curative endoscopic resection of early gastric cancer. Methods During October 2008 to March 2013, data of endoscopic resection of early gastric cancer （ inclu- ding the high-grade intraepithelial neoplasia） were collected. The six factors including gender, age, lesion location, lesion size, lesion type of morphology and with ulceration were analyzed whether they were associat- ed with en bloc resectability and curability of endoscopic resection（ER） ; The main causes of non-curative resection were also analyzed. Results From the included 94 cases including 94 lesions of early gastric canc- er. Twenty cases were diagnosed as high-grade intraepithelial neoplasia,70 lesions were diagnosed as cancer limited in mucosal layer, and four lesions were diagnosed as cancer infiltrating superficial submucosal layer （500 μm form mucosal muscularis）. Five lesions were treated by EMR and 89 lesions were resected by ESD. ER en bloc resection rate was 95.7% （90/94） and the curative resection rate was 79. 8% （75/94）. The curative resection of the lesions in diameter more than 3. 0cm was significantly lower than the lesions in diameter no more than 2. 0 cm （P = 0. 022, OR = 0. 108,95 % CI： 0. 0160-0. 721 ）. And the curative resection of the lesions with ulceration was significantly lower than the lesions without ulceration （ P = 0. 047, OR = 0. 149,95% CI： 0. 023-0. 971 ）. Non-curative resection is mainly due to the positive side edge of the residual tumor cells. Conclusion Lesions in diameter more than 3.0cm and with ulceration were the risk factors to curation resection of ER for early gastric cancer