内镜黏膜下剥离术治疗早期胃食管结合部癌的短期疗效分析

摘要:目的 探讨内镜切除治疗早期胃食管结合部癌的安全性和有效性。方法 收集安徽医科大学第一附属医院2016年4月—2018年10月收治的行内镜黏膜下剥离术 （ESD） 治疗的早期胃食管结合部癌患者共166例, 记录患者的性别、 年龄、 ESD治疗过程、 术后病理、 追加手术治疗情况以及术后随访资料。结合病理结果, 分别按早期胃癌内镜下切除的适应证分类、 eCrua评分系统进行淋巴结转移风险评估。结果 166例早期胃食管结合部癌患者中ESD术后治愈性切除146例 （88.0%）; 非治愈性切除20例 （12.0%）, 其中9例追加手术治疗。非治愈性切除组中病变直径＞ 30 mm、 合并溃疡、 未分化型患者比例高于治愈性切除组 （P＜0.05）。患者术后平均随访15.7 （3~33） 个月, 期间1例出现复发, 无胃癌相关死亡病例。术后eCura C级共4例, 2例局部有肿瘤残留, 1例淋巴结转移。结论 对于符合治疗适应证的早期胃食管结合部癌, ESD治疗是安全、 有效的。术后结合病理结果对患者进行eCura评分可以较好地评估其淋巴结转移的风险。

Short-term outcomes of endoscopic submucosal dissection for early adenocarcinoma of gastroesophageal junction

Abstract： Objective To evaluate the safety and short-term outcomes of endoscopic resection in the treatment of early adenocarcinoma of gastroesophageal junction. Methods A total of 166 patients with early adenocarcinoma of gastroesophageal junction were treated by endoscopic submucosal dissection (ESD) from April 2016 to October 2018 in the First Affiliated Hospital of Anhui Medical University. The clinical information, including gender, age, the process of ESD treatment, post-operative pathology and additional surgical treatment were recorded. The risk assessment of lymph node metastasis was carried out according to the indications of eCrua scoring system and scores of endoscopic resection of early gastric cancer respectively. Results Among the 166 patients with early adenocarcinoma of gastroesophageal junction, 146 (88.0%) were cured after ESD, 20 cases (12.0%) were non-curable resection, 9 cases (5.4%) were transferred to perform additional operation. In the non-curable resection group, the proportion of patients with lesion diameter > 30 mm, lesions with ulcer or undifferentiated type was significantly higher than that in the curable resection group (P＜0.05). The average postoperative follow-up time was 15.7 months (3-33 months). During the follow-up period, 1 case showed recurrence and no case of death associated with gastric cancer. After operation, there were 4 cases of eCura C, 2 cases of local residual tumors and 1 case of lymph node metastasis. Conclusion ESD is safe and effective for the treatment of early adenocarcinoma of gastroesophageal junction. The risk of lymph node metastasis can be well assessed by eCura score system according to the postoperative pathological results.