摘要
随着早期胃癌检出率的提高，内镜治疗得到越来越多的应用并成为胃癌治疗的重要组成部分。因此，规范开展早期胃癌的内镜治疗显得尤为重要。理论上，无淋巴结转移、内镜下能完整切除病变的早期胃癌可进行内镜治疗，内镜治疗的绝对适应证为直径≤2 cm、不伴有溃疡或溃疡瘢痕的分化型黏膜内癌（pT1a）；扩大适应证则包括直径〉2 cm、不伴有溃疡的分化型pT1a期肿瘤，直径≤2 cm、伴有溃疡的分化型pT1a期肿瘤以及直径≤2 cm、不伴有溃疡的未分化型pT1a期肿瘤。术前评估胃癌状态的途径包括内镜、CT以及超声内镜；对于肿瘤直径〉 3 cm、未分化型病变的术前评估需谨慎，避免T分期被低估。在进行内镜手术时，需再次明确病灶的范围、性质和浸润深度，必要时借助染色帮助定位。为避免出血和穿孔等并发症的发生，术中注意及时止血及抽吸气体。内镜治疗后，如病理学检查切除标本示切缘阳性、病变侵犯至黏膜下层深层、有血管累及或胃周淋巴结转移可能性较大，建议追加外科手术。即使被评估为已根治的患者仍然需密切随访。只有严格把握内镜治疗的适应证、准确地进行术前评估、精细地进行术中操作、严密地开展术后随访，才能使接受内镜治疗的胃癌患者真正获益。
With the increasing incidence of early gastric cancer, endoscopic treatment has been widely used. It has also played an important role in the diagnosis and treatment of gastric cancer. Therefore, it is very important to carry out standardized treatment with endoscopy. In theory, endoscopic resection can be performed in early gastric cancers which have no lymph node metastasis and also can be resected completely. Endoscopic therapy is absolutely indicated in macroscopically intramucosal differentiated carcinomas （pT1a） without ulcer or ulcer scar and with diameter ≤ 2 cm. The expanded indications are： （1） macroscopically intramucosal differentiated carcinomas （pT1a） without ulcer and with diameter 〉 2 cm; （2） macroscopically intramucosal differentiated carcinomas （pT1a） with ulcer and with diameter ≤ 2 cm; （3） macroscopically intramucosal undifferentiated carcinomas （pT1a） without ulcer and with diameter ≤ 2 cm.Methods of preoperative evaluation include endoscopy, CT, and endoscopic ultrasonography （EUS） . For tumor size greater than 3 cm and undifferentiated lesions, evaluation should be carried out carefully in order to avoid the underestimation of T staging. During endoscopic surgery, the extent, nature, and depth of the lesion should be clearly defined again, if necessary, assisted by staining endoscopy. In order to avoid complications such as bleeding and perforation, stanch bleeding and aspiration of gas should be performed promptly during the operation. After endoscopic resection, when pathology reveals positive margin of resected specimen, lesions invading deep submucosa, vascular involvement or peri-gastric lymph node metastasis, additional surgery should be recommended. Even if the patients have been evaluated as radical treatment, close follow-up is still necessary. Only when surgeons strictly obey the indications of endoscopic treatment, make the accurate evaluations for the patients before operation, undergo endoscopic operation carefully, and perform the follow up closely, the patients can be benefit from endoscopic therapy really.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第8期865-867,共3页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
早期
内镜治疗
适应证
Stomach neoplasms, early
Endoscopic therapy
Indications
