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目的:评估黏膜下层早期贲门癌的内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)治疗效果。方法:2011年1月—2018年3月，南京市高淳人民医院消化科10例和南京大学医学院附属鼓楼医院136例病例纳入回顾性分析，146例患者(147处病变)均行ESD治疗，最终病理证实均为黏膜下层早期贲门癌。主要观察指标为短期疗效(整块切除率、完整切除率、治愈性切除率)和长期疗效(五年总体生存率、五年疾病特异性生存率)。结果:ESD整块切除率、完整切除率和治愈性切除率分别为100.0%(147/147)、84.4%(124/147)和38.8%(57/147)。75处浸润至黏膜下浅层(浸润深度<500 μm，SM1)的病变中，57处为扩大适应证，均为治愈性切除；其余18处为超适应证，均为非治愈性切除。72处浸润至黏膜下深层(浸润深度≥500 μm，SM2)的病变，均为超适应证和非治愈性切除。中位随访时间43个月(2～101个月)，133例完成随访，五年总体生存率为90.9%。133例完成随访患者中，扩大适应证者(50例)的五年总体生存率为95.7%，超适应证者(83例)的五年总体生存率为88.5%，两者差异无统计学意(n P＝0.48)；扩大适应证者的五年疾病特异性生存率为100.0%，超适应证者的五年疾病特异性生存率为97.5%，两者差异无统计学意义(n P＝0.26)。n 结论:对于符合ESD扩大适应证的黏膜下层早期贲门癌，ESD是一种有效的治疗方案；而对于ESD超适应证的黏膜下层早期贲门癌，ESD切除也有较好的预后，但术后要进行密切随访。“,”Objective:To evaluate the outcomes of early gastric cardiac cancer with submucosal invasion treated with endoscopic submucosal dissection (ESD).Methods:A retrospective study was performed on data of 147 ESD-resected early gastric cardiac cancer with submucosal invasion in consecutive 146 patients over the period between January 2011 and June 2018 at Affiliated Drum Tower Hospital of Nanjing University Medical School (136 patients) and Gaochun People′s Hospital (10 patients). Short-term outcome results (n en bloc, complete, and curative resection rates) and post-resection patient survival (5-year overall survival rate and disease-specific survival rate)were investigated.n Results:The n en bloc, complete, and curative resection rates were 100.0% (147/147), 84.4% (124/147), and 38.8% (57/147), respectively. In the 75 tumors with SM1 (depth of invasion<500 μm), 57 were expanded indication with curative resection and 18 others were beyond indication with non-curative resection. All the 72 tumors with SM2 (depth of invasion≥500 μm) underwent non-curative resection beyond indication. The median follow-up period was 43 months (2-101 months), and 133 patients were followed up. The 5-year overall survival rate was 90.9% for the cohort, not significantly different between expanded indication group (95.7%) and beyond indication group (88.5%) (n P=0.48). The difference in the 5-year disease-specific survival rate was not significant between expanded indication group (100.0%) and beyond indication group (97.5%) (n P=0.26).n Conclusion:ESD is an effective treatment option with favorable outcomes for early gastric cardiac cancer with submucosal invasion in expanded indication. Patients in the beyond indication show favorable clinical outcomes but need to be carefully followed up after ESD.