内镜黏膜下剥离术治疗不同浸润深度早期胃癌的安全性及相关因素分析

目的:探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗不同浸润深度早期胃癌的临床安全性及其相关影响因素。方法:收集2012年01月01日至2018年12月31日在我院行ESD术的早期胃癌患者的临床相关资料，根据ESD术后病理，比较黏膜内癌组（M）与浅层黏膜下癌组（浸润深度≤500 μm，SM1）患者的临床特征及临床预后，运用Logistic回归模型分析影响ESD术治愈性切除的相关因素。结果:276例患者中，M组247例，SM1组29例。M组与SM1组在病变大小、病变部位、术后病理类型方面差异有统计学意义（P＜0.05）；M组治愈性切除率远高于SM1组（94.74% vs 65.52%，χ2=29.007，P<0.05）；M组与SM1组3年生存率（96.21% vs 86.67%），差异无统计学意义（χ2=0.540，P=0.463），术后并发症的发生差异也无统计学意义（P=0.572）；有溃疡和浸润深度SM1是影响ESD术治愈性切除的相关因素。结论:ESD治疗不同浸润深度早期胃癌，浸润深度SM1层的治愈性切除率低于局限于M层，但3年的生存率两组无差异；溃疡、浸润深度达SM1层是影响患者ESD术治愈性切除的独立危险因素。

Safety and related factors of endoscopic submucosal dissection for early gastric cancer with different invasion depths

Objective:To investigate the clinical safety and related influencing factors of endoscopic submucosal dissection (ESD) for early gastric cancer with different invasion depths.Methods:The clinically relevant data of patients with early gastric cancer who underwent ESD from January 1,2012 to December 31,2018 were collected.The clinical characteristics and clinical prognosis of patients with intramucosal cancer group (M) and superficial submucosal cancer group(infiltration depth≤500 μm,SM1) were compared according to the pathology of ESD after surgery.Logistic regression model was used to analyze the related factors affecting the curative resection of ESD.Results:Of the 276 patients,247 were in the M group and 29 were in the SM1 group.There were statistically significant differences in lesion size,lesion location,and postoperative pathological type between group M and SM1 (P<0.05).The curative resection rate in group M was much higher than that in SM1 (94.74% vs 65.52%,χ2=29.007,P<0.05).The 3-year survival rate (96.21% vs 86.67%) of the M group and the SM1 group was not statistically significant (χ2=0.540,P=0.463),and there was no significant difference in the incidence of postoperative complications (P=0.572).The presence of ulcers and depth of infiltration SM1 was a relevant factor affecting the curative resection of ESD.Conclusion:In the treatment of early gastric cancer with different invasion depths,the curable resection rate of SM1 layer was lower than that limited to M layer,but there was no difference in 3-year survival rate between the two groups.Ulceration and infiltration depth up to SM1 layer are independent risk factors for patients with ESD curable resection.