ESD治疗近、远端早期胃癌的疗效比较及影响因素分析

Comparison of the Efficacy of ESD in the Treatment of Proximal and Distal Early Gastric Cancer and Analysis of the Influencing Factors

摘要: 目的：探讨内窥镜下黏膜剥离术(ESD)对近、远端早期胃癌和癌前病变的疗效以及与之有关的影响因素。方法：采用回顾性方式收集2019年4月至2023年8月在安徽医科大学第二附属医院消化科接受ESD治疗，并由术后病理组织学证实为早期胃癌和癌前病变患者的常规临床信息。这项研究共包含126名患者，根据肿瘤位置划分成近端胃(N = 49)和远端胃(N = 77)，对两组患者的基本资料、手术效果等进行比较。根据治疗结果分为治愈组(N = 110)和非治愈组(N = 16)，单因素及Logistic回归分析患者的临床资料，探寻非治愈性切除的危险因素。结果：(1) 近端胃有49.0%的患者伴有高血压，明显高于远端胃的27.3% (P < 0.05)；两组在年龄、病变类型及是否合并溃疡具有统计学意义(P < 0.05)；(2) 近端胃非治愈性切除率明显高于远端胃(P < 0.05)，在手术用时、术后住院天数及发生并发症方面二者差异无统计学意义。(3)单因素及Logistic回归分析表明病变部位、组织类型及浸润深度是影响ESD疗效的主要影响因素。结论：ESD术治疗近、远端早期胃癌的手术安全性一致，病变位于贲门、组织类型为未分化型胃癌及黏膜下浸润是影响ESD疗效的主要危险因素。

Abstract: Objective: To investigate the efficacy of endoscopic mucosal dissection (ESD) on proximal and distal early gastric cancer and precancerous lesions and its influencing factors. Methods: Routine clinical information was collected retrospectively from April 2019 to August 2023 from patients who underwent ESD in the Department of Gastroenterology of the Second Affiliated Hospital of Anhui Medical University and were confirmed to have early gastric cancer and precancerous lesions by postoperative pathological histology. This study included a total of 126 patients, divided into proximal stomach (N = 49) and distal stomach (N = 77) according to the tumour location, and the basic information and surgical results of the two groups were compared. According to the treatment results, they were divided into a cured group (N = 110) and a non-cured group (N = 16), and the clinical data of the patients were analysed by univariate and logistic regression to explore the risk factors for non-cured resection. Results: (1) 49.0% of patients with proximal stomach were accompanied by hypertension, which was significantly higher than that of 27.3% in the distal stomach (P < 0.05); the two groups were statistically significant in terms of age, type of lesion, and whether or not it was combined with ulcers (P < 0.05); (2) the rate of non-curative resection of the proximal stomach was significantly higher than that of the distal stomach (P < 0.05), and the difference was not statistically significant in terms of the time spent on surgery, the number of days of hospital stay after operation, and occurrence of complications between the two. The difference was not statistically significant. (3) Univariate and logistic regression analyses showed that lesion site, tissue type and infiltration depth were the main factors affecting the efficacy of ESD. Conclusion: The surgical safety of ESD for proximal and distal early gastric cancer is consistent, and the main risk factors of ESD are the location of the lesion in the cardia, the type of undifferentiated gastric cancer and submucosal infiltration.