摘要
目的比较内镜黏膜下剥离(endoscopic submucosal dissection,ESD)与外科手术治疗早期胃癌的安全性和预后。方法收集2010年1月~2018年10月我院因早期胃癌行ESD 213例以及外科手术209例的临床资料,进行倾向性评分匹配,2组各95例,比较ESD及外科手术的安全性及预后。结果①原始队列中,ESD组中位随访时间21(10,46)月,外科手术组54(30,85)月(Z=-8.985,P=0.000),ESD组与外科手术组总生存率无显著差异(97.6%vs.96.5%,log-rank χ^(2)=0.772,P=0.380),但无复发生存率显著低于外科手术组(94.8%vs.98.4%,log-rank χ^(2)=4.667,P=0.031)。经倾向性评分匹配后,ESD组与外科手术组的总生存率和无复发生存率均无显著差异(100%vs.97.4%,log-rankχ2=0.671,P=0.413;98.6%vs.97.7%,log-rank χ^(2)=0.023,P=0.879)。②原始队列中,ESD组手术时间显著小于外科手术组[58(55,90)min vs.270(210,315)min,Z=-15.974,P=0.000],住院日较外科手术组显著缩短[11(9,13)d vs.18(14,22)d,Z=-13.428,P=0.000],术后转入ICU的比例显著低于外科手术组[1.4%(3/213)vs.18.2%(38/209),χ^(2)=33.835,P=0.000],倾向性评分匹配后这些指标2组差异仍有统计学意义(均P=0.000)。结论ESD与外科手术治疗早期胃癌的远期疗效相当,且ESD手术时间短,术后进ICU比例低,住院日短。
Objective To compare the safety and long-term outcomes of endoscopic submucosal dissection(ESD)and surgical resection for early gastric cancer(EGC).Methods Clinical data of 213 EGC patients who underwent ESD and 209 EGC patients who underwent surgical resection were retrospectively collected.After propensity-score matching,95 patients in the ESD group and 95 patients in the surgical resection group were finally matched.The safety and long-term outcomes were compared between the two groups.Results①Before propensity-score matching,the median follow-up time was 21(10,46)months in the ESD group and 54(30,85)months in the surgical resection group(Z=-8.985,P=0.000).There was no difference in overall survival rate between the ESD group and the surgical resection group(97.6%vs.96.5%,log-rank χ^(2)=0.772,P=0.380),while the recurrence free survival rate was significantly lower in the ESD group than that in the surgical resection group(94.8%vs.98.4%,log-rank χ^(2)=4.667,P=0.031).After propensity-score matching,the overall survival and recurrence free survival rate of the ESD group were comparable to those of the surgical resection group(100%vs.97.4%,log-rankχ2=0.671,P=0.413;98.6%vs.97.7%,log-rank χ^(2)=0.023,P=0.879).②Before propensity-score matching,the procedure time[58(55,90)min vs.270(210,315)min,Z=-15.974,P=0.000]and the length of hospital stay[11(9,13)d vs.18(14,22)d,Z=-13.428,P=0.000]were significantly shorter in the ESD group than those in the surgical resection group,and the proportion of ICU transfer was significantly lower in the ESD group[1.4%(3/213)vs.18.2%(38/209),χ^(2)=33.835,P=0.000].After propensity-score matching,the procedure time and the length of hospital stay were still significantly shorter in the ESD group than those in the surgical resection group(all P=0.000).Conclusions The long-term outcomes of ESD is comparable to that of surgery in the treatment of EGC.Moreover,ESD is associated with lower ICU transfer rate,shorter procedure time,and shorter hospital stay.
作者
赵中凯
王晔
刘鑫
俎明
张静
丁士刚
Zhao Zhongkai;Wang Ye;Liu Xin(Department of Gastroenterology,Peking University Third Hospital,Beijing 100191,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第6期416-421,共6页
Chinese Journal of Minimally Invasive Surgery
