| Objective: To evaluate the efficacy of 160 patients with early gastric cancer and precancerous lesions treated by endoscopic submucosal dissection(ESD),and analyze the relationship between the curative effect with this method and the different characteristics of patients and lesions,and the complications and recurrence,providing a clinical basis for the individualized treatment of patients with early gastric cancer.Method:160 cases of ESD-treated patients with single early gastric cancer and precancerous lesion were collected at endoscopy center of The Second Hospital of Dalian Medical University from January 1,2013 to October 31,2018.Group according to gender: 93 males,67 females;according to age,106 patients were aged 60 years or above,and 54 patients were aged less than 60 years;according to the location of the lesion,8 patients occurred at cardia or gastric fundus,24 patients at gastric body,20 patients at the gastric angle and 108 patients at gastric antrum;according to Paris endoscopic classification: there were 40 cases of type I,116 cases of type II,and 4 cases of type III;according to the lesion length: there were 107 patients with the lesion size less than or equal to 2cm,27 patients with the lesion size larger than 2cm and less than or equal to 3cm,and 26 patients with the lesion larger than 3cm;according to ulcer or no ulcer: there were 22 cases of ulcer and 138 cases of no ulcer;according to the infiltration depth: there were 150 cases in the mucosa layer and 10 cases in the submucosa layer;according to the histopathological type:90 cases of low-grade intraepithelial neoplasia,33 cases of high-grade intraepithelial neoplasia,29 cases of differentiated carcinoma(including high and medium differentiated adenocarcinoma),8 cases of undifferentiated carcinoma(including low differentiated adenocarcinoma and signet-ring cell carcinoma).Retrospective analysis was used to evaluate the degree of cure,complications,recurrence and survival of the patients.The statistical methods include chi-square test and logistic regression analysis.Results:1.A total of 160 patients,the average operation time was 73.59 minutes,the average number of days in hospital after the operation was 5.43 days.The enbloc resection rate was 99.38%(159/160),the complete resection rate was 96.88%(155/160),the curative resection rate was 95.00%(152/160),and the non-curative resection rate was 5.00%(8/160).2.The complications rate was 7.50%(12/160),the intraoperative perforation rate was 1.25%(2/160),the delayed bleeding rate was 2.50%(4/160),and the postoperative fever rate was 3.75%(6/160).All the above complications were cured by conservative treatment,and no other complications occurred.3.Postoperative additional surgery was performed in 7 cases,the other 153 cases were followed up,and the follow-up rate was 100%(153/153),the average follow-up time was 2 years(3-72 months).There were 3 cases of recurrence during this period,with a recurrence rate of 1.96%(3/153),2 deaths,and a 2-year survival rate of 98.69%(151/153).4.Single factor analysis results show that:(1)The curative resection rate of patients with lesion infiltration in the mucosa was higher than that of patients with lesion infiltration in the submucosa(96.67% vs.70.00%),P<0.05.(2)The curative resection rates were different in patients with low-grade intraepithelial neoplasia,high-grade intraepithelial neoplasia,differentiated carcinoma and undifferentiated carcinoma(98.89%,100.00%,89.66%,50.00%),P < 0.05.(3)There was no significant difference in the rates of curative resection and non-curative resection between groups in terms of gender,age,lesion site,lesion size,endoscopic classification,and the presence or absence of ulceration,P>0.05.5.Logistic multivariate analysis showed that the risk of non-curative resection increased in patients with pathologically undifferentiated carcinoma(OR=74.21,95%CI: 4.36-1263.56,P = 0.003),P < 0.05.Conclusions:1.ESD treatment for early gastric cancer is effective,with low risk,less complications and shorter hospitalization time.2.ESD can effectively remove precancerous lesions and prevent carcinogenesis.3.Infiltration depth and pathological type were the influencing factors of curative resection of tumor.4.Pathological type is an independent risk factor for non-curative resection.5.For patients with early gastric cancer infiltrating into the submucosa and poor differentiation,strict preoperative evaluation and postoperative comprehensive consideration are needed to select a reasonable treatment plan. |
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