目的：评价国内单中心采用内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）治疗早期胃癌（early gastric cancer, EGC）的安全性及有效性。方法：回顾性分析北京大学肿瘤医院2011年1月至2013年12月因单发EGC接受ESD治疗病例的临床病理资料，分别从临床特征、病理结果、治愈性评价、手术并发症及术后随访几个方面进行分析。结果：共计116例EGC病例纳入本研究，包括男性88例，女性28例，中位年龄63岁（25~80岁）。术后病理组织学分型包括高级别上皮内瘤变28例（24.1%）、高分化腺癌35例（30.2%）、中分化腺癌35例（30.2%）及低分化腺癌18例（15.5%）。87例（75.0%）肿瘤局限于黏膜层，18例（15.5%）侵及黏膜下层浅层，11例（9.5%）侵及黏膜下层深层。病灶平均直径（1.49±0.96） cm，17例（14.7%）EGC合并溃疡形成。病灶整块切除率为95.7%（111/116），完整切除率为93.1%（108/116），总治愈性切除率为77.6%（90/116），其中，62例（53.4%）为标准的治愈性切除（standard curative resection, sCR）， 28例（24.2%）为扩大的治愈性切除（expanded curative resection, eCR），26例（22.4%）为非治愈性切除（noncurative resection, nCR）。sCR组病灶平均直径小于eCR组及nCR组，差异具有统计学意义（t=－4.121, P<0.001及t=－3.420, P=0.001）。nCR组0~Ⅲ型病例的比例及合并溃疡形成的比例更高，且差异具有统计学意义（χ2=10.287, P=0.006及χ2=17.737, P<0.001）。多因素分析显示，EGC合并溃疡形成及肿瘤浸润黏膜下层是导致非治愈性切除的因素（OR=6.634, P=0.006及OR=12.735, P<0.001）。ESD相关并发症包括术后出血4例（3.4%）、术中穿孔3例（2.6%）、术后贲门狭窄2例（1.7%）及术后心衰1例（0.9%）。共有106例患者进入随访，除1例于术后8个月出现局部复发外，其余105例患者未见复发及转移，中位随访时间为22个月（12~47个月）。结论：ESD是治疗EGC安全且可行的手段，合并溃疡形成及肿瘤浸润达黏膜下层是导致非治愈性切除的因素，穿孔及术后出血是主要的并发症。

Objective：To evaluate the clinical outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in a single center in China. Methods:We performed a retrospective ana-lysis of the patients with single EGC lesion who received ESD in Peking University Cancer Hospital from January 2011 to December 2013.Their clinicopathologic data, resectability, curability, complications and follow-up data were assessed. Results:A total of 116 patients were enrolled in the study. The patients included 88 men and 28 women, with a median age of 63 years (range: 25-80 years).The post-operative histology of the lesions included 28 (24.1%) high grade intraepithelial neoplasia, 35 (30.2%) well differentiated adenocarcinoma, 35 (30.2%) moderated differentiated adenocarcinoma and 18 (15.5%) poorly differentiated adenocarcinoma. Of all the lesions, 75.0% (87/116) were confined into mucosa, 15.5% (18/116) invaded SM1 (<500 μm from the muscularis mucosae) and 9.5% (11/116) invaded SM2 (≥500 μm from the muscularis mucosae). The mean tumor size was (1.49±0.96) cm, and the rate of ulceration was 14.7% (17/116). The en bloc resection rates were 96.7% (111/116), complete resection rates were 93.1% (108/116) and curative resection rates were 77.6% (90/116). According to the curability, 62 (53.4%) cases were classified into the standard curative resection (sCR) group, 28 (24.2%) into the expanded curative resection (eCR) group and 26 (22.4%) into thenoncurative resection (nCR) group. The mean tumor size of the sCR group was smaller than that of the eCR and nCR group (t=－4.121, P<0.001 and t=－3.420, P=0.001). In the nCR group, the portion of type 0-Ⅲ  lesion and ulceration were significantly higher (χ2=10.287, P=0.006 and  χ2=17.737, P<0.001). In multivariate analysis, EGC with ulceration and submucosal invasion were the risk factors for non-curative resection (OR=6.634, P=0.006 and OR=12.735, P<0.001). The ESD-related complications included 4 (3.4%) post-operative bleeding, 3 (2.6%) intra-operative perforation, 2 (1.7%) cardiac stenosis and 1 (0.9%) heart failure. In the study, 106 of the 116 patients received periodic follow-up, during a median follow-up of 22 months(12-47 months), Local tumor recurrence developed in 1 patient of the eCR group 8 months post the ESD.Conclusion:ESD is a safe and feasible option for EGC in China, ulceration and submucosal invasion are associated with noncurative resection, and post-operative bleeding and intra-operative perforation should be concerned as the main complications.