高级别上皮内瘤变及早期胃癌内镜与外科治疗在随访及经济指标中评估研究  

Endoscopic therapy versus surgery for treatment of high-grade intraepithelial neoplasia and early gastric cancer:a comparative study of efficacy and economics

作　　者：张顽军[1,2] 潘文胜[1] 陈光兰[3] 徐翔[1] 吾红光[4] 范晓圆[1] 胡雯[1] 朱一苗[1] 韩铁妹[1] 

机构地区：[1]浙江大学医学院附属第二医院,浙江杭州310009 [2]浙江大学医学院附属义乌医院,浙江义乌322000 [3]丽水市人民医院,浙江丽水323000 [4]浙江大学医学院附属第二医院衢江分院,浙江衢州324000

出　　处：《实用肿瘤杂志》2012年第3期264-267,共4页Journal of Practical Oncology

基　　金：国家公益卫生行业专项基金(200802112);浙江省中医药管理局基金(2007ZA018);浙江省自然科学基金(Y12H160121;Y2080001);浙江省科技厅重大科技专项(2009C03012-5);浙江省卫生厅基金(2007A093;2011KYA167)

摘　　要：目的探讨内镜与外科手术治疗高级别上皮内瘤变及早期胃癌术后残胃及吻合口黏膜改变、费用及治疗时间、随访复发情况。方法收集25例内镜治疗及100例外科手术治疗患者,分别从术后黏膜改变状态(充血、糜烂、溃疡、伴随胆汁反流)、治疗费用与时间、术后随访复发情况3方面评估,利用SPSS 16.0统计软件进行统计。结果外科手术术后黏膜明显充血者87.0%,糜烂36.0%,溃疡9.0%,伴随胆汁反流高达48.0%,内镜组除手术瘢痕外无明显术后黏膜炎性改变(P<0.001);外科手术组平均花费为(3.56±1.12)万元,平均住院时间(20±9)天,内镜治疗组平均费用(0.57±0.42)万元,平均治疗时间(5±2)天(P<0.001);外科组随访中见1例复发,内镜治疗组无复发(P>0.05)。结论内镜切除治疗高级别上皮内瘤变不仅能显著改善术后黏膜状态、降低治疗费用、缩短恢复时间,而且具有与外科手术类似良好预后。Objective To compare the differences of endoscopic therapy and surgery in anastomatic mucosal changes of residual stomach,expenses,hospitalization time,and recurrence in treatment of high-grade intraepithelial neoplasia（HIN） and early gastric cancer.Methods Twenty-five and 100 cases were collected from January 2005 to January 2010 receiving endoscopic therapy and surgery,respectively,and compared by statistical analysis in anastomatic mucosal changes of residual stomach（congestion,erosion,ulceration,accompanied by bile reflux）,expenses and hospitalization time and recurrence with SPSS 16.0 Software.Results The rate of obvious congestion of stomach mucosa in surgery group was 87.0%,erosion 36.0%,ulceration 9.0%,accompanied bile reflux 48.0%,while patients in endoscopic group did not have obvious mucosal changes except scar（P0.001）;expenses in surgery group was（35 600±11 200） yuan,hospitalization time was（20±9） days in average,while those in the endoscopic group cost（5 700±4 200） yuan in average,and hospitalization time for about（5±2） days,which was significantly different in statistics（P0.001）.There was one case of recurrence in surgery group and none in endoscopic therapy group（P0.05）.Conclusion Endoscopic resection of high-grade intraepithelial neoplasia and early gastric cancer not only improves the mucosal changes post treatment,lowers the expenses,shortens the recovery time,but also has the similar prognosis as surgery.

关 键 词：胃肿瘤/外科学 内窥镜检查 上皮内瘤样病变 复发 预后 

分 类 号：R735.2[医药卫生—肿瘤]