目的

比较术前评估超内镜治疗适应证胃癌采用超级微创手术新型内镜腹腔镜联合术（NCELS）同时治疗和内镜、腔镜序贯治疗的临床价值，优化NCELS 的治疗方案。

方法

回顾性统计2018 年1 月至2024 年1 月经陆军军医大学第一附属医院术前评估为超内镜治疗适应证胃癌47例并拟用NCELS 治疗。 同时治疗组24例，内镜、腔镜序贯治疗23例，分析比较同时治疗和序贯治疗的术前、术后病理诊断和治疗方案的差异。

结果

同时治疗组24例患者中，术前术后超内镜治疗适应证诊断一致21例、3例术后诊断为内镜下治疗适应证，均进行了腔镜淋巴结清扫；序贯治疗组23例患者中，术前术后超内镜治疗适应证诊断一致7例，补充了淋巴结清扫、16例术后病理诊断为内镜下治疗适应证，未行淋巴结清扫。 序贯治疗组的手术时间、住院费用、并发症发生均低于同时治疗组，且手术时间和住院费用有显著性差异（P＜0.01）。

结论

优化后的NCELS 内镜、腔镜序贯治疗依据术后内镜切除标本的病理，决定是否补充腔镜淋巴结清扫，对术前超内镜治疗适应证过判断的病例，避免了外科腔镜介入，治疗更精准、微创。

Objective

To compare the clinical value of preoperative evaluation of gastric cancer beyong the indications of endoscopic with simultaneous treatment using super minimally invasive surgery-Novel combined endoscopic and laparoscopic surgery （NCELS） and sequential endoscopic and laparoscopic treatment， and to optimize the treatment regimen of NCELS.

Method

47 cases of gastric cancer preoperatively evaluated as an indication beyond endoscopic treatment in the First Affiliated Hospital of Army Military Medical University between January 2018 and January 2024 were retrospectively counted，all of which were proposed to be treated with NCELS. There were 24 cases in the simultaneous treatment group and 23 cases in the sequential treatment group， analyzing and comparing the differences in preoperative and postoperative pathological diagnosis and treatment options between simultaneous and sequential treatment.

Results

24 patients in the simultaneous treatment group， of which 21 were diagnosed consistently with preoperative and postoperative beyond endoscopic indications for treatment， 3 were diagnosed postoperatively with endoscopic indications for treatment， and all 24 underwent lymph node dissection. There were 23 patients in the sequential treatment group， among which 7 cases with consistent diagnosis of preoperative and postoperative beyond endoscopic treatment indications supplemented lymph node dissection， and the remaining 16 cases with postoperative pathological diagnosis of endoscopic treatment indications did not undergo lymph node dissection. The factors of gastric cancer lesion size and differentiation degree have a greater influence on preoperative in-depth diagnosis. The operation time， hospitalization cost and complication occurrence in the sequential treatment group were lower than those in the simultaneous treatment group，and there was a significant difference in operation time and hospitalization cost （P ＜0. 01）.

Conclusion

The optimized NCELS endoscopic and sequential treatment is based on the pathology of the postoperative endoscopic resection specimen，which determines whether to supplement the lymph node dissection or not，and avoids surgical laparoscopic intervention in which the indications for preoperative beyond endoscopic treatment are over-judged，making the treatment more precise and minimally invasive.