Shi Qiang, Zhu Junyu, Dai Chunhong, Zhou Pinghong, Xu Meidong, Chen Weifeng, Ren Zhong, Chen Tao, Cai Shilun, Wu Yiren, Zhong Yunshi, Yao Liqing
Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Feb;18(2):155-8.
To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy.
Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated.
Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5(range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40(10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation, and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36(6-78) months without discomfort and recurrence under gastroscopy.
ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.
探讨内镜黏膜下剥离术（ESD）治疗胃癌根治术后残胃早期胃癌（EGC）及癌前病变的可行性和疗效。
回顾性分析2008年1月至2013年12月在中山医院内镜中心接受ESD治疗的36例残胃EGC及癌前病变患者的临床资料，评估手术情况、术后状况及长期随访情况。
成功率和完整切除率均为100%。肿瘤平均最大直径为1.5（范围0.6 - 4.5）cm。ESD过程中，2例出血经内镜止血成功处理。平均手术时间为40（10 - 80）分钟。2例术后1 - 3天发生迟发性出血，也经内镜止血成功处理。无穿孔或迟发性穿孔发生。并发症无需急诊手术。12例诊断为轻 - 中度异型增生，7例为高级别上皮内瘤变，16例为增生性息肉，1例为印戒细胞癌T1期，ESD术后7天行残胃切除及淋巴结清扫术，未进行后续随访。根治性切除率为92.7%（35/36）。其余35例患者中位随访时间为36（6 - 78）个月，胃镜检查无不适及复发。
ESD治疗残胃EGC及癌前病变安全有效。
