内镜黏膜下剥离术与外科手术治疗早期胃癌对比研究
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摘要
目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)与外科手术治疗早期胃癌的临床疗效和预后。方法早期胃癌患者107例,根据手术方式分为ESD组47例和外科手术组60例,比较2组手术时间、术后恢复时间、完全切除率、手术并发症和术后复发情况,采用Kaplan-Meier法进行生存分析。结果 ESD组手术时间[(89.0±7.4)min]和术后恢复时间[(8.4±4.3)d]明显短于外科手术组[(226.1±42.9)min、(15.5±13.0)d](P<0.05),完全切除率(83.0%)和并发症发生率(8.5%)低于外科手术组(100.0%、28.3%),3 a完全生存率(100.0%)、3 a无病生存率(97.5%)和复发率(2.5%)与外科手术组(100.0%、100.0%、0)比较差异均无统计学意义(P>0.05)。结论 ESD治疗早期胃癌的预后与外科手术相当,且手术时间短,术后恢复快、并发症少。
Objective To investigate the clinical efficacy and prognosis of endoscopic submucosal dissection(ESD) versus surgical treatment of early gastric cancer. Methods Totally 107 patients with early gastric cancer were divided into 47 patients undergoing ESD(ESD group) and 60 patients undergoing surgical treatment(surgical group). The operative time, postoperative recovery time, complete resection rate, surgical complications and postoperative recurrence were compared between two groups. Kaplan-Meier was used to analyze the survival. Results The operative time((89.0±7.4) min) and postoperative recovery time((8.4±4.3) d) in ESD group were significantly shorter than those in surgical group((226.1±42.9) min,(15.5±13.0) d), the complete resection rate(83.0%) and complication rate(8.5%) were significantly lower than those in surgical group(100.0%, 28.3%), and there were no significant differences in the 3-year overall survival rate(100.0% vs. 100.0%), 3-year disease-free survival rate(97.5% vs. 100.0%) and recurrence rate(2.5% vs. 0) between ESD group and surgical group(P>0.05). Conclusion ESD has the same prognosis as surgery in the treatment of early gastric cancer, with short operative time, quick postoperative recovery and few complications.
Objective To investigate the clinical efficacy and prognosis of endoscopic submucosal dissection(ESD) versus surgical treatment of early gastric cancer. Methods Totally 107 patients with early gastric cancer were divided into 47 patients undergoing ESD(ESD group) and 60 patients undergoing surgical treatment(surgical group). The operative time, postoperative recovery time, complete resection rate, surgical complications and postoperative recurrence were compared between two groups. Kaplan-Meier was used to analyze the survival. Results The operative time((89.0±7.4) min) and postoperative recovery time((8.4±4.3) d) in ESD group were significantly shorter than those in surgical group((226.1±42.9) min,(15.5±13.0) d), the complete resection rate(83.0%) and complication rate(8.5%) were significantly lower than those in surgical group(100.0%, 28.3%), and there were no significant differences in the 3-year overall survival rate(100.0% vs. 100.0%), 3-year disease-free survival rate(97.5% vs. 100.0%) and recurrence rate(2.5% vs. 0) between ESD group and surgical group(P>0.05). Conclusion ESD has the same prognosis as surgery in the treatment of early gastric cancer, with short operative time, quick postoperative recovery and few complications.
引文
[1] 汤瑜,邱全兴,胡学军,等.窄带成像联合放大内镜在早期胃癌诊断中价值[J].中华实用诊断与治疗杂志,2017,31(8):797-798.
[2] 廖专,孙涛,吴浩,等.中国早期胃癌筛查及内镜诊治共识意见(2014年4月·长沙)[J].胃肠病学,2014,19(7):408-427.
[3] 北京市科委重大项目《早期胃癌治疗规范研究》专家组,柴宁莉,翟亚奇,等.早期胃癌内镜下规范化切除的专家共识意见(2018,北京)[J].中华胃肠内镜电子杂志,2018,5(2):49-60.
[4] Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2014 (Ver. 4)[J]. Gastric Cancer,2016,20(1):1-19.
[5] 邱全兴,汤瑜,徐威,等.放大内镜结合窄带成像技术靶向活检诊断早期胃癌价值[J].中华实用诊断与治疗杂志,2016,30(12):1233-1235.
[6] ABE S, ODA I, MINAGAWA T, et al. Metachronous gastric cancer following curative endoscopic resection of early gastric cancer[J]. Clin Endosc,2017,51(3):253-259.
[7] LEE J Y, CHOI I J, KIM C G, et al. Therapeutic decision-making using endoscopic ultrasonography in endoscopic treatment of early gastric cancer[J]. Gut Liver,2016,10(1):42-50.
[8] NIE R C, YUAN S Q, CHEN X J, et al. Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: a meta-analysis[J]. World J Surg Oncol,2017,15(1):113-120.
[9] 刘莉,史维.ESD术后并发症及处置[J].现代消化及介入诊疗,2014,19(4):247-251.
[10] LIM S M, PARK J C, LEE H, et al. Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm[J]. Surg Endosc,2013,27(4):1397-1403.
[11] CHOI I J, LEE N R, KIM S G, et al. Short-term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: a prospective multicenter cohort study[J]. Gut Liver,2016,10(5):739-748.
[12] 崔盈盈,卢忠生,令狐恩强,等.内镜黏膜下剥离术对治疗早期胃癌的临床应用价值[J].胃肠病学和肝病学杂志,2013,22(4):341-343.
[2] 廖专,孙涛,吴浩,等.中国早期胃癌筛查及内镜诊治共识意见(2014年4月·长沙)[J].胃肠病学,2014,19(7):408-427.
[3] 北京市科委重大项目《早期胃癌治疗规范研究》专家组,柴宁莉,翟亚奇,等.早期胃癌内镜下规范化切除的专家共识意见(2018,北京)[J].中华胃肠内镜电子杂志,2018,5(2):49-60.
[4] Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2014 (Ver. 4)[J]. Gastric Cancer,2016,20(1):1-19.
[5] 邱全兴,汤瑜,徐威,等.放大内镜结合窄带成像技术靶向活检诊断早期胃癌价值[J].中华实用诊断与治疗杂志,2016,30(12):1233-1235.
[6] ABE S, ODA I, MINAGAWA T, et al. Metachronous gastric cancer following curative endoscopic resection of early gastric cancer[J]. Clin Endosc,2017,51(3):253-259.
[7] LEE J Y, CHOI I J, KIM C G, et al. Therapeutic decision-making using endoscopic ultrasonography in endoscopic treatment of early gastric cancer[J]. Gut Liver,2016,10(1):42-50.
[8] NIE R C, YUAN S Q, CHEN X J, et al. Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: a meta-analysis[J]. World J Surg Oncol,2017,15(1):113-120.
[9] 刘莉,史维.ESD术后并发症及处置[J].现代消化及介入诊疗,2014,19(4):247-251.
[10] LIM S M, PARK J C, LEE H, et al. Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm[J]. Surg Endosc,2013,27(4):1397-1403.
[11] CHOI I J, LEE N R, KIM S G, et al. Short-term outcomes of endoscopic submucosal dissection in patients with early gastric cancer: a prospective multicenter cohort study[J]. Gut Liver,2016,10(5):739-748.
[12] 崔盈盈,卢忠生,令狐恩强,等.内镜黏膜下剥离术对治疗早期胃癌的临床应用价值[J].胃肠病学和肝病学杂志,2013,22(4):341-343.