内镜黏膜下剥离术治疗老年早期贲门癌的疗效分析及对患者预后的影响  

Therapeutic efficacy and prognosis of endoscopic submucosal dissection for elderly patients with early gastric cardiac cancer

作　　者：蔡仁颂 杨维忠[1] 崔光锐 温必盛 卢利军 CAI Ren-song;YANG Wei-zhong;CUI Guang-rui(Department of Digestive Endoscopy,the Second Affiliated Hospital of Hainan Medical University,Haikou Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院消化内镜科,海南海口570311 [2]空军第九八六医院第五门诊部,陕西西安710054

出　　处：《临床和实验医学杂志》2022年第14期1505-1509,共5页Journal of Clinical and Experimental Medicine

基　　金：海南省卫健委项目(编号:2019B00465)。

摘　　要：目的探讨老年早期贲门癌患者行内镜黏膜下剥离术(ESD)治疗的疗效及其对患者长期预后的影响。方法将2015年3月至2019年6月在海南医学院第二附属医院进行ESD治疗的299例早期贲门癌患者纳入本次回顾性研究,以年龄界限为60岁分为中青年组(n=104)和老年组(n=195)。比较两组患者的短期疗效及长期预后。结果104例中青年患者共有106个病灶,195例老年患者共有207个病灶。老年组患者年龄高于中青年组,体重指数低于中青年组,差异有统计学意义(P<0.05),其他资料比较差异均无统计学意义(P>0.05)。老年组治愈性切除率为79.7%(165/207),较中青年组的89.6%(95/106)明显降低,差异有统计学意义(P<0.05),两组间整块切除率、完全切除率、并发症发生率、手术时长和住院时长差异均无统计学意义(P>0.05)。本次研究的中位随访为42.5个月,老年组患者ESD后有13.3%(26/195)追加了切除术,较中青年组的14.4%(15/104)稍低,差异均无统计学意义(P>0.05);两组间术后复发、淋巴结及远处转移、总体病死率、疾病相关病死率差异均无统计学意义(P>0.05)。通过Kaplan-Meier分析显示,两组5年的总体生存率(94.8%vs.95.2%)和疾病特异性生存率(99.0%vs.99.5%)比较,差异均无统计学意义(P>0.05)。结论ESD是一种微创、安全、有效的治疗手段,老年早期贲门癌患者可从中获益,且预后良好。Objective To investigate the efficacy and prognosis of endoscopic submucosal dissection(ESD)in elderly patients with early gastric cardiac cancer.Methods 299 patients with early gastric cardiac cancer undergoing ESD in the Second Affiliated Hospital of Hainan Medical University from March 2015 to June 2019 were included in this retrospective study.They were divided into the young and middle-aged group(n=104)and the elderly group(n=195)with an age threshold of 60 years,and the short-term efficacy and long-term prognosis of the two groups were compared.Results There were 106 lesions in 104 young and middle-aged patients and 207 lesions in 195 elderly patients.The age of patients in the elderly group was higher than that of the young and middle-aged group,and the body mass index was lower than that of the young and middle-aged group,and the difference was statistically significant(P<0.05).The proportion of curative resection in the elderly group was 79.7%(165/207),which was significantly lower than that in the young and middle-aged group(89.6%,95/106),and the difference was statistically significant(P<0.05),but there were no significant differences in the whole resection rate,complete resection rate,incidence of postoperative complications,length of surgery and length of hospital stay between the two groups(P>0.05).The median follow-up of this study was 42.5 months,and 13.3%(26/195)of the elderly group had additional surgery after ESD,slightly lower than 14.4%(15/104)of the young and middle-aged group,but there was no significant difference(P>0.05).There were no significant differences in postoperative recurrence,lymph node metastasis,distant metastasis,overall mortality and disease-related mortality between the two groups(P>0.05).Kaplan-meier survival analysis showed that the 5-year overall survival rate and disease-specific survival rate of the elderly group were 94.8%and 99.0%,respectively,had no big different from 95.2%and 99.5%of the young and middle-aged group(P>0.05).Conclusion ESD is a safe and reliable trea

关 键 词：老年 早期贲门癌 内镜黏膜下剥离术 疗效 预后 

分 类 号：R735.2[医药卫生—肿瘤]