内镜黏膜下剥离术治疗早期胃癌及癌前病变的疗效观察
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摘要
目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法选择淳化县医院消化内科2013年1月至2014年2月收治的EGC及癌前病变患者120例为观察组,给予ESD治疗,选择同期进行外科传统手术的EGC及癌前病变患者120例为对照组,比较两组患者的手术时间、术中出血量、肛门排气时间、住院时间、手术疗效、术后6个月复发或转移、术后3年存活率、术后并发症,疼痛程度评分(VAS)。结果观察组和对照组患者的手术时间[(90.4±7.8) min vs (128.9±8.8) min]、术中出血量[(92.1±9.1) mL vs (167.9±8.2) m L]、住院时间[(8.9±1.2) d vs (16.1±2.1) d]、肛门排气时间[(10.2±0.8) h vs (19.2±1.9) h]、VAS评分[(3.1±0.9)分vs (6.1±1.8)分]比较,观察组均明显少于对照组,差异均具有统计学意义(P<0.05);观察组患者术后6个月复发率、转移率和3年存活率分别为2.5%、1.7%、97.5%,分别与对照组的1.7%、3.4%、98.3%比较差异均无统计学意义(P>0.05);观察组患者的肿瘤完整切除率为98.3%,与对照组的99.2%比较差异无统计学意义(P>0.05);观察组患者的并发症发生率为5.8%,明显低于对照组的24.2%,差异具有统计学意义(P<0.05)。结论 ESD治疗EGC及癌前病变疗效理想,手术创伤小,患者恢复快,术后并发症少。
Objective To discuss the clinical effects of endoscopic submucosal dissection(ESD) in the treatment of early gastric carcinoma(EGC) and precancerous lesion. Methods A total of 120 patients with EGC or precancerous lesion from Suihua County Hospital during January 2013 and February 2014 treated with ESD were selected as the observation group, and 120 patients with EGC or precancerous lesion from the hospital during the same time period treated with traditional surgery were chosen as the control group. Then the operative time, intraoperative bleeding volume, anal exhaust time, length of hospital stay, clinical efficacy, 6-month recurrence rate, 3-year survival rate, postoperative complications, Visual Analogue Scale(VAS) were compared between the two groups. Results In the observation group, the operation time, intraoperative bleeding volume, length of hospital stay, anal exhaust time, and VAS score were(90.4±7.8) min,(92.1±9.1) mL,(8.9±1.2) d,(10.2±0.8) h, and 3.1±0.9, significantly lower than(128.9±8.8) min,(167.9±8.2) mL,(16.1±2.1) d,(19.2±1.9) h, 6.1±1.8 of the control group(P<0.05). The 6-month recurrence rate, metastasis rate,and 3-year survival rate were 2.5%, 1.7%, and 97.5% in the observation group, versus 1.7%, 3.4%, and 98.3% in the control group(P>0.05). The complete resection rate of tumors was 98.3% in the observation group, versus 99.2% in the control group(P>0.05). The rate of postoperative complications in the observation group was 5.8%, significantly lower than24.2% in the control group(P<0.05). Conclusion ESD is effective in the treatment of EGC and precancerous lesions,with less trauma, faster recovery, and fewer complications.
Objective To discuss the clinical effects of endoscopic submucosal dissection(ESD) in the treatment of early gastric carcinoma(EGC) and precancerous lesion. Methods A total of 120 patients with EGC or precancerous lesion from Suihua County Hospital during January 2013 and February 2014 treated with ESD were selected as the observation group, and 120 patients with EGC or precancerous lesion from the hospital during the same time period treated with traditional surgery were chosen as the control group. Then the operative time, intraoperative bleeding volume, anal exhaust time, length of hospital stay, clinical efficacy, 6-month recurrence rate, 3-year survival rate, postoperative complications, Visual Analogue Scale(VAS) were compared between the two groups. Results In the observation group, the operation time, intraoperative bleeding volume, length of hospital stay, anal exhaust time, and VAS score were(90.4±7.8) min,(92.1±9.1) mL,(8.9±1.2) d,(10.2±0.8) h, and 3.1±0.9, significantly lower than(128.9±8.8) min,(167.9±8.2) mL,(16.1±2.1) d,(19.2±1.9) h, 6.1±1.8 of the control group(P<0.05). The 6-month recurrence rate, metastasis rate,and 3-year survival rate were 2.5%, 1.7%, and 97.5% in the observation group, versus 1.7%, 3.4%, and 98.3% in the control group(P>0.05). The complete resection rate of tumors was 98.3% in the observation group, versus 99.2% in the control group(P>0.05). The rate of postoperative complications in the observation group was 5.8%, significantly lower than24.2% in the control group(P<0.05). Conclusion ESD is effective in the treatment of EGC and precancerous lesions,with less trauma, faster recovery, and fewer complications.
引文
[1]温越,俎明,丁士刚.早期胃癌的内镜下治疗进展[J].胃肠病学,2018, 23(9):565-568.
[2] NAKAMURA K, HONDA K, AKAHOSHI K, et al. Suitability of the expanded indication criteria for the treatment of early gastric cancer by endoscopic submucosal dissection:Japanese multicenter large-scale retrospective analysis of short-and long-term outcomes[J]. Scandinavian Journal of Gastroenterology, 2015, 50(4):413-422.
[3] ONO H, YAO K, FUJISHIRO M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer[J]. Digestive Endoscopy, 2016, 28(1):3-15.
[4]仲恒高,缪林,季国忠,等.内镜黏膜下剥离术治疗早期胃癌及癌前病变36例临床分析[J].中国内镜杂志, 2016, 22(1):90-92.
[5] HAHN KY, PARK CH, LEE YK, et al. Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer[J]. Surg Endosc, 2018, 32(1):73-86.
[6]鞠辉,钟芸诗,姚礼庆,等.早期食管癌内镜黏膜下剥离术后食管狭窄的危险因素分析[J].中华消化内镜杂志, 2013, 30(6):310-314.
[7] CHOI JH, KIM ES, LEE YJ, et al. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer[J]. Gastrointestinal Endoscopy, 2015,82(2):299-307.
[8]马丽梅,张银,钱云,等.内镜黏膜下注射糖皮质激素联合扩张术治疗早期食管癌内镜黏膜下剥离术后狭窄的初步探索[J].中国微创外科杂志, 2014, 14(8):732-734.
[9] JEON HK, LEE SJ, KIM GH, et al. Endoscopic submucosal dissection for undifferentiated-type early gastric cancer:short-and long-term outcomes[J]. Surgical Endoscopy, 2018, 32(4):1963-1970.
[10]王伟,郝璐,施新岗,等.内镜黏膜下剥离术在早期胃癌及癌前病变治疗中的价值[J].第二军医大学学报, 2017, 38(7):923-927.
[11] LEE S, CHOI KD, HAN M, et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors:a criteria-based analysis[J]. Gastric Cancer, 2018, 21(3):490-499.
[12]周平红,彭贵勇,杨仕明,等.内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效分析[J].第三军医大学学报, 2014, 36(14):1507-1511.
[2] NAKAMURA K, HONDA K, AKAHOSHI K, et al. Suitability of the expanded indication criteria for the treatment of early gastric cancer by endoscopic submucosal dissection:Japanese multicenter large-scale retrospective analysis of short-and long-term outcomes[J]. Scandinavian Journal of Gastroenterology, 2015, 50(4):413-422.
[3] ONO H, YAO K, FUJISHIRO M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer[J]. Digestive Endoscopy, 2016, 28(1):3-15.
[4]仲恒高,缪林,季国忠,等.内镜黏膜下剥离术治疗早期胃癌及癌前病变36例临床分析[J].中国内镜杂志, 2016, 22(1):90-92.
[5] HAHN KY, PARK CH, LEE YK, et al. Comparative study between endoscopic submucosal dissection and surgery in patients with early gastric cancer[J]. Surg Endosc, 2018, 32(1):73-86.
[6]鞠辉,钟芸诗,姚礼庆,等.早期食管癌内镜黏膜下剥离术后食管狭窄的危险因素分析[J].中华消化内镜杂志, 2013, 30(6):310-314.
[7] CHOI JH, KIM ES, LEE YJ, et al. Comparison of quality of life and worry of cancer recurrence between endoscopic and surgical treatment for early gastric cancer[J]. Gastrointestinal Endoscopy, 2015,82(2):299-307.
[8]马丽梅,张银,钱云,等.内镜黏膜下注射糖皮质激素联合扩张术治疗早期食管癌内镜黏膜下剥离术后狭窄的初步探索[J].中国微创外科杂志, 2014, 14(8):732-734.
[9] JEON HK, LEE SJ, KIM GH, et al. Endoscopic submucosal dissection for undifferentiated-type early gastric cancer:short-and long-term outcomes[J]. Surgical Endoscopy, 2018, 32(4):1963-1970.
[10]王伟,郝璐,施新岗,等.内镜黏膜下剥离术在早期胃癌及癌前病变治疗中的价值[J].第二军医大学学报, 2017, 38(7):923-927.
[11] LEE S, CHOI KD, HAN M, et al. Long-term outcomes of endoscopic submucosal dissection versus surgery in early gastric cancer meeting expanded indication including undifferentiated-type tumors:a criteria-based analysis[J]. Gastric Cancer, 2018, 21(3):490-499.
[12]周平红,彭贵勇,杨仕明,等.内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效分析[J].第三军医大学学报, 2014, 36(14):1507-1511.