摘要
目的探讨内镜黏膜下剥离术(ESD)治疗未分化型早期胃癌(UD-EGC)的近远期疗效。方法对2017年1月至2018年9月海南医学院第二附属医院收治的115例UD-EGC患者进行回顾性分析,根据手术方案不同分为两组,其中ESD组67例,手术组48例。比较两组患者基线资料及临床病理特征、近远期疗效及术前、术后血清糖类抗原-125(CA-125)、糖类抗原72-4(CA-724)、癌胚抗原(CEA)及胃泌素-17(G-17)、胃蛋白酶原(PG)表达水平。结果两组性别构成比、年龄、肿瘤部位、溃疡、幽门螺杆菌(Hp)感染等情况比较差异无统计学意义(P>0.05),ESD组肿瘤直径≤2 cm、浸润深度为黏膜层、无脉管癌栓的比率为67.16%、71.64%、100.00%,显著高于手术组(32.84%、41.67%、89.58%),差异均有统计学意义(P<0.05)。ESD组完整切除率、治愈性切除率与手术组相比差异无统计学意义(P>0.05);ESD组手术首次下床时间、术后首次排气时间及术后住院时间为(1.58±0.47)、(2.47±0.75)、(9.15±2.38)d,显著短于手术组[(3.26±0.82)、(4.29±1.03)、(13.87±3.11)d],差异均有统计学意义(P<0.05)。两组出血、穿孔、切口感染、吻合口瘘等围术期并发症发生率比较差异无统计学意义(P>0.05),ESD组肠梗阻及总并发症发生率为0、5.97%,明显低于手术组(8.33%、20.83%),差异有统计学意义(P<0.05)。两组术后3个月血清CA-125、CA-724、CEA及G-17、PG-Ⅱ水平较术前明显降低,PG-I水平较术前明显升高,差异均有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。ESD组和手术组术后3年肿瘤复发率、淋巴结转移率比较,差异均无统计学意义(P>0.05)。结论对于肿瘤直径≤2 cm、黏膜浸润浅且不伴有脉管癌栓的UD-EGC建议行ESD治疗,不仅可以达到外科手术相同的效果,恢复血清肿瘤标志物、G-17、PG水平异常状态,还能促进患者术后恢复。
Objective To investigate the short-term and long-term efficacy of endoscopic submucosal dissection(ESD)in the treatment of undifferentiated early gastric cancer(UD-EGC).Methods A retrospective analysis was performed on 115 patients with UD-EGC admitted to the Second Affiliated Hospital of Hainan Medical University from January 2017 to September 2018.They were divided into two groups according to different surgical plans,including 67 cases in the ESD group and 48 cases in the surgical group.The short-term and long-term efficacy and preoperative and postoperative serum carbohydrate antigen-125(CA-125),carbohydrate antigen 72-4(CA-724),carcinoembryonic antigen(CEA)and gastrin-17(G-17)and pepsinogen(PG)expression levels were compared between the two groups.Results There was no significant difference in gender composition ratio,age,tumor location,ulcer,Helicobacter pylori(Hp)infection between the two groups(P>0.05).The ratios of tumor diameter≤2 cm,invasion depth of mucosal layer,and no vascular tumor thrombus in the ESD group were 67.16%,71.64%and 100.00%,which were significantly higher than those in the surgical group(32.84%,41.67%and 89.58%),and the differences were statistically significant(P<0.05).There was no significant difference in the complete resection rate and cure resection rate between the ESD group and the surgical group(P>0.05).The first postoperative ambulation time,the first postoperative exhaust time and the postoperative hospital stay in the ESD group were(1.58±0.47)d,(2.47±0.75)d,(9.15±2.38)d,which were significantly shorter than those in the surgical group[(3.26±0.82)d,(4.29±1.03)d,(13.87±3.11)d],and the differences were statistically significant(P<0.05).There was no difference in the incidence of perioperative complications such as bleeding,perforation,incision infection and anastomotic leakage between the two groups(P>0.05).The incidence of intestinal obstruction and total complications in ESD group was 0,5.97%,which was significantly lower than that in surgical group(8.33%,20.83%),and
作者
李微
陈晓莉
翁乙花
LI Wei;CHEN Xiao-li;WENG Yi-hua(Department of Digestive Endoscopy,the Second Affiliated Hospital of Hainan Medical University,Haikou Hainan 570311,China)
出处
《临床和实验医学杂志》
2022年第5期491-494,共4页
Journal of Clinical and Experimental Medicine
基金
海南省卫生计生行业科研项目(编号:20A200212)。
