胃低级别上皮内瘤变内镜下射频消融术后复发患者处置的临床研究

doi:10.3877/cma.j.issn.2095-7157.2022.04.003

中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (04) : 207 -211. doi: 10.3877/cma.j.issn.2095-7157.2022.04.003

论著

胃低级别上皮内瘤变内镜下射频消融术后复发患者处置的临床研究

王楠钧¹, 柴宁莉¹, 令狐恩强¹^,^†(

), 牛晓彤¹, 刘圣圳¹, 李隆松¹, 张文刚¹, 王沙沙¹, 高飞²

^1. 100853　北京，解放军总医院第一医学中心消化内科医学部
^2. 100853　北京，解放军总医院第一医学中心消化内科医学部；334000　江西，解放军73123部队

收稿日期:2022-10-20 出版日期:2022-11-15
通信作者: 令狐恩强
基金资助:
首都特色临床应用研究(Z181100001718177)

Clinical study on the management of patients with recurrent gastric low-grade intraepithelial neoplasia after endoscopic radiofrequency ablation

Nanjun Wang¹, Ningli Chai¹, Enqiang Linghu¹^,^†(), Xiaotong Niu¹, Shengzhen Liu¹, Longsong Li¹, Wengang Zhang¹, Shasha Wang¹, Fei Gao²

^1. Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
^2. Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; Troop 73123, Jiangxi 334000, China

Received:2022-10-20 Published:2022-11-15
Corresponding author: Enqiang Linghu

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引用本文：

王楠钧, 柴宁莉, 令狐恩强, 牛晓彤, 刘圣圳, 李隆松, 张文刚, 王沙沙, 高飞. 胃低级别上皮内瘤变内镜下射频消融术后复发患者处置的临床研究[J/OL]. 中华胃肠内镜电子杂志, 2022, 09(04): 207-211.

Nanjun Wang, Ningli Chai, Enqiang Linghu, Xiaotong Niu, Shengzhen Liu, Longsong Li, Wengang Zhang, Shasha Wang, Fei Gao. Clinical study on the management of patients with recurrent gastric low-grade intraepithelial neoplasia after endoscopic radiofrequency ablation[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(04): 207-211.

目的

本文通过回顾性对比分析，探索胃低级别上皮内瘤变射频消融术后复发患者的临床处置策略。

方法

回顾性选择2014年10月至2022年9月于我中心完成胃低级别上皮内瘤变射频消融治疗术后复发的53例患者，依据其是否接受追加治疗分为随访组与治疗组，对比两组的相关指标。

结果

随访组与治疗组在性别、年龄、病程、病变部位、随访时长方面没有明显差异(P> 0.05)，但治疗组病变消除率明显优于随访组(91.3% vs 43.3%，P< 0.001)，而治疗组三种术式间的疗效差异尚不显著(P＝0.640)。

结论

对于胃低级别上皮内瘤变射频消融术后复发的患者，建议追加内镜下毁损或切除治疗。

关键词: 胃低级别上皮内瘤变, 内镜下射频消融术, 复发

Objective

To explore the clinical management strategy of patients with recurrent gastric low-grade intraepithelial neoplasia after radiofrequency ablation.

Methods

53 patients with recurrent gastric low-grade intraepithelial neoplasia who completed radiofrequency ablation in our center from October 2014 to September 2022 were retrospectively selected and divided into follow-up group and treatment group according to whether they received additional treatment. The relevant indicators of the two groups were compared and analyzed.

Results

There were no significant differences in gender, age, course of disease, site of lesion and duration of follow-up between the two groups (P> 0.05), but the elimination rate of lesion in the treatment group was significantly better than that in the follow-up group (91.3% vs 43.3%, P< 0.001). However, there was no significant difference between the three surgical methods in the treatment group (P= 0.640).

Conclusion

Additional endoscopic ablation or resection is recommended for patients with recurrent gastric low-grade intraepithelial neoplasia after radiofrequency ablation.

Key words: Gastric low-grade intraepithelial neoplasia, Endoscopic radiofrequency ablation, Recurrence

图1 内镜下发现病变

图2 放大内镜联合窄带成像精细评估病变

图3 内镜下射频消融术

图4 术后随访(原治疗区域活检)

表1 随访组与治疗组基线资料及随访对比情况[例(%)]

项目		随访组(n＝30)	治疗组(n＝23)	P值
性别				0.061
	男	16(53.3)	18(78.3)
	女	14(46.7)	5(21.7)
年龄(岁)		58.2±9.1	60.0±7.5	0.454
病程(月)		21.8±11.2	19.0±11.3	0.374
病变部位				1.000
	胃底(含贲门)~胃体	2(6.7)	1(4.3)
	胃角	11(36.7)	8(34.8)
	胃窦(含幽门)	17(56.7)	14(60.9)
随访时长(月)		28.8±22.0	25.4±17.7	0.547
病变是否消退				<0.001
	是	13(43.3)	21(91.3)
	否	17(56.7)	2(8.7)

表1 随访组与治疗组基线资料及随访对比情况[例(%)]

项目		随访组(n＝30)	治疗组(n＝23)	P值
性别				0.061
	男	16(53.3)	18(78.3)
	女	14(46.7)	5(21.7)
年龄(岁)		58.2±9.1	60.0±7.5	0.454
病程(月)		21.8±11.2	19.0±11.3	0.374
病变部位				1.000
	胃底(含贲门)~胃体	2(6.7)	1(4.3)
	胃角	11(36.7)	8(34.8)
	胃窦(含幽门)	17(56.7)	14(60.9)
随访时长(月)		28.8±22.0	25.4±17.7	0.547
病变是否消退				<0.001
	是	13(43.3)	21(91.3)
	否	17(56.7)	2(8.7)

表2 治疗组三种术式对比情况[例(%)]

治疗方法	病变消退(n＝21)	病变未消退(n＝2)
RFA	13(61.9)	1(50)
APC	4(19)	1(50)
ESD	4(19)	0
P值	0.640

表2 治疗组三种术式对比情况[例(%)]

治疗方法	病变消退(n＝21)	病变未消退(n＝2)
RFA	13(61.9)	1(50)
APC	4(19)	1(50)
ESD	4(19)	0
P值	0.640

[1]	Liu Y，Cai Y，Chen S，et al.Analysis of Risk Factors of Gastric Low-Grade Intraepithelial Neoplasia in Asymptomatic Subjects Undergoing Physical Examination[J]．Gastroenterol Res Pract，2020，2020：7907195.
[2]	den Hollander WJ，Holster IL，den Hoed CM，et al.Surveillance of premalignant gastric lesions：a multicentre prospective cohort study from low incidence regions[J]. Gut，2019，68(4)：585-593.
[3]	北京医学会消化内镜学分会．胃低级别上皮内瘤变规范化诊治专家共识(2019，北京)[J/CD]．中华胃肠内镜电子杂志，2019，6(2)：49-56.
[4]	Wu S，Zhu X，Xiang L，et al.The Diagnostic Accuracy of Conventional Forceps Biopsy Compared to ESD[J]．Open Med (Wars)，2017，12：261-265.
[5]	Jeon JW，Kim SJ，Jang JY，et al.Clinical Outcomes of Endoscopic Resection for Low-Grade Dysplasia and High-Grade Dysplasia on Gastric Pretreatment Biopsy: Korea ESD Study Group[J]．Gut Liver, 2021，15(2)：225-231.
[6]	令狐恩强，冯佳，马晓冰，等．内镜下射频消融术治疗食管和胃低级别上皮内瘤变的临床研究[J/CD]．中华胃肠内镜电子杂志，2015，2(1)：14-17.
[7]	Wang NJ，Chai NL，Tang XW，et al.Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia[J]. World J Gastrointest Oncol，2022，14(3)：724-733.
[8]	冯佳．内镜射频消融治疗胃低级别上皮内瘤变的实验及临床研究[D]．中国人民解放军总医院；解放军医学院，2017.
[9]	冯佳，令狐恩强．胃低级别上皮内瘤变的内镜诊疗技术进展[J/CD]．中华胃肠内镜电子杂志，2017，4(1)：29-32.
[10]	Park SY，Jeon SW，Jung MK，et al.Long-term follow-up study of gastric intraepithelial neoplasias: progression from low-grade dysplasia to invasive carcinoma[J]．Eur J Gastroenterol Hepatol，2008，20(10)：966-970.
[11]	王宇菲，张波，令狐恩强，等．从胃低级别上皮内瘤变切除标本看此类患者的处置原则[J/CD]．中华腔镜外科杂志(电子版)，2013，6(6)：410-414.
[12]	Zhang Y，Wu X，Zhang C，et al.Dissecting expression profiles of gastric precancerous lesions and early gastric cancer to explore crucial molecules in intestinal-type gastric cancer tumorigenesis[J]. J Pathol，2020，251(2)：135-146.
[13]	Li F，Zhu H，Tao K，et al.Mucosal microbial microenvironment in early gastric neoplasia and non-neoplastic gastric disease[J]．J Gastroenterol Hepatol，2021, 36(11): 3092-3101.
[14]	李宝，柴宁莉，汤小伟，等．胃低级别瘤变内镜下氩离子凝固术后局部复发的影响因素[J/CD]．中华腔镜外科杂志(电子版)，2021，14(2)：104-108.
[15]	Wang N，Chai N，Li L，et al.Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia：A Large-Scale Retrospective Study[J]．Can J Gastroenterol Hepatol, 2022，2022：2349940.
[16]	Kim B，Kim BJ，Seo IK，et al.Cost-effectiveness and short-term clinical outcomes of argon plasma coagulation compared with endoscopic submucosal dissection in the treatment of gastric low-grade dysplasia[J]．Medicine (Baltimore)，2018，97(15)：e0330.
[17]	Jung SJ，Cho SJ，Choi IJ，et al.Argon plasma coagulation is safe and effective for treating smaller gastric lesions with low-grade dysplasia：a comparison with endoscopic submucosal dissection[J]．Surg Endosc，2013，27(4)：1211-1218.
[18]	Quiroz-Guadarrama CD，Herrera-Esquivel JJ，Rojano-Rodríguez M, et al. Endoscopic gastric submucosal dissection in low-grade intraepithelial neoplasia[J]. Rev Gastroenterol Mex, 2014，79(2)：149-151.
[19]	Huh CW，Kim J，Kim BW，et al.Pathologic Validation of Endoscopic Ablative Therapy for Gastric Epithelial Neoplasia: A Randomized Controlled Trial[J]．Turk J Gastroenterol，2021，32(12)：1029-1037.

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Clinical study on the management of patients with recurrent gastric low-grade intraepithelial neoplasia after endoscopic radiofrequency ablation

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Clinical study on the management of patients with recurrent gastric low-grade intraepithelial neoplasia after endoscopic radiofrequency ablation