内镜黏膜下剥离术对胃肠神经内分泌肿瘤患者疗效研究
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摘要
目的通过对比分析内镜黏膜下剥离术对胃肠神经内分泌肿瘤患者有效性及炎性反应的影响,为治疗胃肠神经内分泌肿瘤提供理论依据。方法选取胃肠神经内分泌肿瘤56例患者为研究对象。按照随机数字法分为研究组和对照组,两组各28例患者。研究组患者采用内镜黏膜下剥离术治疗,对照组患者采用内镜黏膜下切除术方法治疗。观察两组患者病情变化,记录患者手术过程中出现的不良反应、手术时间等情况,记录患者住院时间,观察和分析患者病变部位切除情况、血清Cg A、Syn水平和炎性因子水平等指标。结果研究组患者手术时间和平均时间均短于对照组患者,差异有统计学意义(P <0. 05);研究组患者病变部位整块切除率低于对照组,但是完全切除率明显高于对照组,差异有统计学意义(P <0. 05);手术后,研究组患者TNF-α、IL-6水平下降了(60. 95±2. 27) ng/l、(5. 69±1. 77) ng/l,CRP水平升高了(44. 38±7. 24) mg/l,对照组患者TNF-α、IL-6水平下降了(74. 76±2. 63) ng/l、(5. 55±2. 50) ng/l,CRP水平升高了(24. 29±4. 84) mg/l。手术后,研究组患者血清TNF-α、IL-6和CRP指标水平与对照组患者相比,差异有统计学意义(P <0. 05);研究组患者术后血清Cg A和Syn水平均低于对照组患者,差异有统计学意义(P <0. 05)。结论内镜黏膜下剥离术与传统的手术方法比较,能缩短患者住院时间,提高治疗效果,降低患者术后并发症,提高患者生存率,值得广泛推广应用。
Objective To analyze the influence of endoscopic submucosal dissection on the effectiveness and inflammatory response of gastrointestinal neuroendocrine tumors,and to provide a theoretical basis for the treatment of gastrointestinal neuroendocrine tumors. Methods 56 patients with gastrointestinal neuroendocrine tumors were selected as the study subjects. According to the random number method,28 patients in each group were divided into study group and control group. Endoscopic submucosal dissection was used in the study group and endoscopic submucosal resection was used in the control group. The changes of the two groups were observed closely. The adverse reactions and operation time during the operation were recorded. The patients Hospitalization time,observation and analysis of patients with lesion removal,serum Cg A,Syn levels and inflammatory cytokines and other indicators. Results The operation time and average time of the study group were shorter than those of the control group( P <0. 05). The resection rate of the lesion in the study group was lower than that of the control group,but the complete resection rate was significantly higher than that of the control group( P < 0. 05). After operation,the levels of TNF-α and IL-6 in the study group decreased by( 60. 95 ± 2. 27) ng·l-1 and( 5. 69 ± 1. 77) ng·l-1,and the CRP level increased by( 44. 38 ± 7. 24)mg·l-1,The level of TNF-αand IL-6 in the control group decreased by( 74. 76 ±2. 63) ng·l-1 and( 5. 55 ± 2. 50) ng·l-1,while the CRP level increased by( 24. 29 ± 4. 84) mg·l-1. After operation,the levels of serum TNF-α,IL-6 and CRP in the study group were significantly lower than those in the control group( P < 0. 05). The levels of serum Cg A and Syn in the study group were lower than those in the control group Group patients,the difference was statistically significant( P < 0. 05). Conclusion Endoscopic submucosal dissection and traditional operative methods can shorten the hospitalization time,improve the treatment effect,reduce postoperative complications and improve the survival rate of patients,so it is worthy of wide application.
Objective To analyze the influence of endoscopic submucosal dissection on the effectiveness and inflammatory response of gastrointestinal neuroendocrine tumors,and to provide a theoretical basis for the treatment of gastrointestinal neuroendocrine tumors. Methods 56 patients with gastrointestinal neuroendocrine tumors were selected as the study subjects. According to the random number method,28 patients in each group were divided into study group and control group. Endoscopic submucosal dissection was used in the study group and endoscopic submucosal resection was used in the control group. The changes of the two groups were observed closely. The adverse reactions and operation time during the operation were recorded. The patients Hospitalization time,observation and analysis of patients with lesion removal,serum Cg A,Syn levels and inflammatory cytokines and other indicators. Results The operation time and average time of the study group were shorter than those of the control group( P <0. 05). The resection rate of the lesion in the study group was lower than that of the control group,but the complete resection rate was significantly higher than that of the control group( P < 0. 05). After operation,the levels of TNF-α and IL-6 in the study group decreased by( 60. 95 ± 2. 27) ng·l-1 and( 5. 69 ± 1. 77) ng·l-1,and the CRP level increased by( 44. 38 ± 7. 24)mg·l-1,The level of TNF-αand IL-6 in the control group decreased by( 74. 76 ±2. 63) ng·l-1 and( 5. 55 ± 2. 50) ng·l-1,while the CRP level increased by( 24. 29 ± 4. 84) mg·l-1. After operation,the levels of serum TNF-α,IL-6 and CRP in the study group were significantly lower than those in the control group( P < 0. 05). The levels of serum Cg A and Syn in the study group were lower than those in the control group Group patients,the difference was statistically significant( P < 0. 05). Conclusion Endoscopic submucosal dissection and traditional operative methods can shorten the hospitalization time,improve the treatment effect,reduce postoperative complications and improve the survival rate of patients,so it is worthy of wide application.
引文
[1] Yang DH,Park Y,Park SH,et al. Cap-assisted EMR for rectal neuroendocrine tumors:comparisons with conventional EMR and endoscopic submucosal dissection(with videos)〔J〕. Gastrointestinal Endoscopy,2016,83(5):1015-1022.
[2] Baek IH,Kim SH. Mo1075 The Effectiveness of Endoscopic Submucosal Resection With a Ligation Device for Small Rectal Carcinoid Compared With Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection:An Analysis of 59 Cases〔J〕. Gastrointestinal Endoscopy,2016,83(5):452-452.
[3]方海明,王业流,李玥,等.改良的圈套器行内镜黏膜下剥离术切除结直肠息肉及黏膜下肿瘤的疗效评价〔J〕.中国内镜杂志,2017,23(2):1-5.
[4] Mori H,Rahman A,Kobara H,et al. Novel and effective countertraction using a ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection〔J〕. Gastrointestinal Endoscopy,2016,84(4):735-736.
[5]张其德,韩树堂.经内镜侧缘切开隧道技术在治疗胃黏膜下肿瘤中的初步应用〔J〕.中华消化内镜杂志,2017,34(4):281-283.
[6] Yu Sasaki,Yasuhiko Abe,Kazuya Yoshizawa,et al. Su1487Impact of Diabetes Mellitus on Postoperative Bleeding After Endoscopic Submucosal Dissection for Esophago-Gastric Tumor〔J〕. Gastrointestinal Endoscopy,2015,81(5):303-303.
[7]何云飞,罗宴吉,冯仕庭,等.多排螺旋CT和超声内镜诊断胃肠道神经内分泌肿瘤的对比分析〔J〕.中国CT和MRI杂志,2017,15(7):107-109.
[8]张雨,彭晓洁,金凯舟,等.基于中国六家医疗中心数据的结直肠神经内分泌肿瘤临床病理特征及预后分析〔J〕.中华胃肠外科杂志,2016,19(11):1235-1240.
[9] Chieko,Tsuchida,Naoto,et al. Clinical importance of colonoscopy in patients with gastric neoplasm undergoing endoscopic submucosal dissection〔J〕. World Journal of Gastroenterology,2017,23(23):4262-4269.
[10]沈丹杰,陈柯,孙蕴伟.超声内镜数字图像分析技术对胰腺神经内分泌肿瘤良恶性鉴别的作用初探〔J〕.中华消化杂志,2017,37(1):13-18.
[11] Kim JW,Jang JY,Lee TI. Su1488 Clinicopathological Characteristics of Patients With Pain After Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasm〔J〕. Gastrointestinal Endoscopy,2015,81(5):AB303-AB303.
[12]高东锋,吕文浩,张林慧,等.内镜与外科手术治疗直肠小神经内分泌肿瘤的回顾性对比研究〔J〕.中华消化内镜杂志,2016,33(7):447-450.
[13] Kato M,Uraoka T,Wada M,et al. Laterally spreading tumor involving a colon diverticulum successfully resected by endoscopic submucosal dissection.〔J〕. Gastrointestinal Endoscopy,2016,84(1):191-192.
[14]齐志鹏,钟芸诗,周平红,等.内镜切除结直肠黏膜下肿瘤临床病理学特征分析(附559例报告)〔J〕.中国实用外科杂志,2016,36(1):115-118.
[15] Kawata N,Ono H,Kakushima N,et al. Mo1351 Polyglycolic Acid Sheets with Fibrin Glue can Reduce the Risk of Bleeding after Gastric Endoscopic Submucosal Dissection for Patients Continuing Antithrombotic Therapy〔J〕. Gastrointestinal Endoscopy,2016,83(5):AB466-AB466.
[2] Baek IH,Kim SH. Mo1075 The Effectiveness of Endoscopic Submucosal Resection With a Ligation Device for Small Rectal Carcinoid Compared With Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection:An Analysis of 59 Cases〔J〕. Gastrointestinal Endoscopy,2016,83(5):452-452.
[3]方海明,王业流,李玥,等.改良的圈套器行内镜黏膜下剥离术切除结直肠息肉及黏膜下肿瘤的疗效评价〔J〕.中国内镜杂志,2017,23(2):1-5.
[4] Mori H,Rahman A,Kobara H,et al. Novel and effective countertraction using a ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection〔J〕. Gastrointestinal Endoscopy,2016,84(4):735-736.
[5]张其德,韩树堂.经内镜侧缘切开隧道技术在治疗胃黏膜下肿瘤中的初步应用〔J〕.中华消化内镜杂志,2017,34(4):281-283.
[6] Yu Sasaki,Yasuhiko Abe,Kazuya Yoshizawa,et al. Su1487Impact of Diabetes Mellitus on Postoperative Bleeding After Endoscopic Submucosal Dissection for Esophago-Gastric Tumor〔J〕. Gastrointestinal Endoscopy,2015,81(5):303-303.
[7]何云飞,罗宴吉,冯仕庭,等.多排螺旋CT和超声内镜诊断胃肠道神经内分泌肿瘤的对比分析〔J〕.中国CT和MRI杂志,2017,15(7):107-109.
[8]张雨,彭晓洁,金凯舟,等.基于中国六家医疗中心数据的结直肠神经内分泌肿瘤临床病理特征及预后分析〔J〕.中华胃肠外科杂志,2016,19(11):1235-1240.
[9] Chieko,Tsuchida,Naoto,et al. Clinical importance of colonoscopy in patients with gastric neoplasm undergoing endoscopic submucosal dissection〔J〕. World Journal of Gastroenterology,2017,23(23):4262-4269.
[10]沈丹杰,陈柯,孙蕴伟.超声内镜数字图像分析技术对胰腺神经内分泌肿瘤良恶性鉴别的作用初探〔J〕.中华消化杂志,2017,37(1):13-18.
[11] Kim JW,Jang JY,Lee TI. Su1488 Clinicopathological Characteristics of Patients With Pain After Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasm〔J〕. Gastrointestinal Endoscopy,2015,81(5):AB303-AB303.
[12]高东锋,吕文浩,张林慧,等.内镜与外科手术治疗直肠小神经内分泌肿瘤的回顾性对比研究〔J〕.中华消化内镜杂志,2016,33(7):447-450.
[13] Kato M,Uraoka T,Wada M,et al. Laterally spreading tumor involving a colon diverticulum successfully resected by endoscopic submucosal dissection.〔J〕. Gastrointestinal Endoscopy,2016,84(1):191-192.
[14]齐志鹏,钟芸诗,周平红,等.内镜切除结直肠黏膜下肿瘤临床病理学特征分析(附559例报告)〔J〕.中国实用外科杂志,2016,36(1):115-118.
[15] Kawata N,Ono H,Kakushima N,et al. Mo1351 Polyglycolic Acid Sheets with Fibrin Glue can Reduce the Risk of Bleeding after Gastric Endoscopic Submucosal Dissection for Patients Continuing Antithrombotic Therapy〔J〕. Gastrointestinal Endoscopy,2016,83(5):AB466-AB466.