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目的:探讨内镜黏膜下剥离术(ESD)治疗未分化型早期胃癌的疗效及预后。方法:回顾性分析2010年1月—2019年4月在南京医科大学第一附属医院行ESD治疗且术后病理证实为早期胃癌的393例患者(400处病灶)的临床病理资料，根据术后病理结果分为未分化癌组(50例，50个病灶)和分化癌组(343例，350个病灶)，收集患者年龄、性别，切除病灶大小及部位、大体分型、浸润深度、有无溃疡及术后随访情况等进行分析。结果:Logistic回归分析表明年龄≤60岁(n OR＝2.02，95%n CI：1.04～3.95，n P＝0.011)、女性(n OR＝2.83，95%n CI：1.41～5.68，n P＝0.003)、胃窦部病变(n OR＝3.92，95%n CI：1.65～9.30，n P＝0.002)、凹陷型病变(n OR＝5.37，95%n CI：2.16～13.38，n P<0.001)及浸润至黏膜下层(n OR＝5.09，95%n CI：2.40～10.80，n P<0.001)为未分化型早期胃癌发生的独立危险因素。393例患者中，非治愈性切除113例，治愈性切除280例。未分化癌组非治愈性切除率高于分化癌组[90.0%(45/50)比19.8%(68/343),n χ2＝104.902，n P<0.001]。非治愈性切除患者死亡率高于治愈性切除[4.4%(5/113)比0.7%(2/280),n χ2＝5.558，n P＝0.023]。未分化癌组27例患者追加手术，分化癌组51例追加手术，无一例复发；315例未追加手术患者中，未分化癌组复发率高于分化癌组[26.1%(6/23)比4.1%(12/292), n χ2＝5.560，n P<0.001]。n 结论:年龄≤60岁、女性、胃窦部病变、凹陷型病变及浸润至黏膜下层为未分化型早期胃癌发生的独立危险因素。未分化型早期胃癌非治愈性切除率高、ESD术后易复发，建议追加外科手术治疗。“,”Objective:To evaluate the efficacy and prognosis of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC).Methods:Data of 393 patients with 400 EGC lesions who underwent ESD between January 2010 and April 2019 in the First Affiliated Hospital of Nanjing Medical University were collected in the retrospective study. Patients were divided into undifferentiated-type group (50 cases with 50 lesions) and differentiated-type group (343 cases with 350 lesions) according to postoperative pathology. Their data including age, gender, size and location of the resected lesion, general classification, depth of infiltration, presence or absence of ulcers, and follow-up were compared.Results:Logistic regression analysis showed that age ≤60 years (n OR=2.02, 95%n CI: 1.04-3.95, n P=0.011), female (n OR=2.83, 95%n CI: 1.41-5.68, n P=0.003), gastric antrum lesions (n OR=3.92, 95%n CI: 1.65-9.30, n P=0.002), endoscopic depressed type (n OR=5.37, 95%n CI: 2.16-13.38, n P<0.001), and submucosa invasive depth (n OR=5.09, 95%n CI: 2.40-10.80, n P<0.001) were independent risk factors for undifferentiated EGC. The undifferentiated-type group showed a significantly higher non-curative resection rate [90.0% (45/50) VS 19.8% (68/343),n χ2=104.902, n P<0.001]. Of the 393 patients, 5(4.4%) died in the 113 patients with non-curative resection, while 2 (0.7%) died in the 280 patients with curative resection. Patients with non-curative resection had a higher mortality (n χ2=5.558, n P=0.023). There were 27 and 51 patients undergoing additional surgery in the undifferentiated-type group and the differentiated-type group, respectively. None of them had recurrence. Among the 315 patients who did not undergo surgery, the recurrence rate of the undifferentiated-type group was significantly higher than that of the differentiated-type group [26.1% (6/23) VS 4.1% (12/292), n χ2=5.560, n P<0.001].n Conclusion:Young age (≤60 years), female, gastric antrum lesions, endoscopic depressed type, and submucosa invasive depth are predictors of undifferentiated EGC. Patients with undifferentiated EGC have a higher non-curative resection rate and higher possibility of recurrence after ESD, and additional operation are suggested.