早期胃癌患者行ESD与EMR的疗效比较及对血清CA125、胃蛋白酶原水平的影响  

Comparison on the curative effect of ESD and EMR on patients with early gastric cancer and their influences on serum CA125and pepsinogen

作　　者：雷洪军 潘金[1] 刘杰[1] 姚勇[1] 奉镭[1] LEI Hong-jun;PAN Jin;LIU Jie;YAO Yong;FENG Lei(The Fifth Ward,Digestive Center,Suining Central Hospital,629000Suining,Sichuan,China)

机构地区：[1]遂宁市中心医院消化中心五病区,四川遂宁629000

出　　处：《临床消化病杂志》2023年第3期203-206,共4页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]探讨早期胃癌(EGC)患者行内镜黏膜下剥离术(ESD)与内镜下黏膜切除术(EMR)的疗效比较及对血清CA125、胃蛋白酶原水平的影响。[方法]选取EGC患者118例,依据ESD、EMR治疗手段将其分为ESD组(63例)和EMR组(55例)。比较2组病灶切除情况、围手术期情况、术后并发症发生及胃癌复发情况,以及2组手术前后血清CA125、PG水平变化。[结果]ESD组病灶治愈性切除率高于EMR组(P<0.05);ESD组术中出血量高于EMR组,且手术时间长于EMR组,2组比较P<0.05;2组胃肠道功能恢复时间及住院时间比较,差异无统计学意义(P>0.05)。术后2组患者血清糖类抗原-125(CA125)及胃蛋白酶原(PG)Ⅱ水平较术前均有降低(P<0.05);且ESD组PGⅡ水平低于EMR组(P<0.05)。ESD组和EMR组患者血清PGⅠ水平较术前均有提升(P<0.05);且ESD组高于EMR组(P<0.05)。术后6个月内,ESD组患者胃癌复发率低于EMR组(P<0.05);2组术后并发症发生率比较,差异无统计学意义(P>0.05)。[结论]ESD对EGC的治疗效果显著,相较于EMR治疗,ESD能更完整的切除癌肿病灶,降低血清CA125水平,调节PG分泌,促进胃内腺体功能恢复,降低EGC的复发风险,但其术中操作较EMR更复杂,切除组织范围更大,需谨慎操作以降低出血及穿孔风险。[Objective]To explore the comparison on curative effect of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)on patients with early gastric cancer(EGC)and their influences on serum carbohydrate antigen-125(CA125)and pepsinogen(PG).[Methods]A total of 118patients with EGC admitted to the hospital were enrolled during January 2018and January 2021.According to different treatment methods,they were divided into ESD group(ESD,63cases)and EMR group(EMR,55cases).The lesions resection,perioperative conditions,postoperative complications and recurrence of gastric cancer,and changes in levels of serum CA125and PG before and after surgery between the two groups were compared.[Results]The cured resection rate of lesions in ESD group were higher than those in EMR group(P<0.05).The intraoperative blood loss in ESD group was more than that in EMR group,and operation time was longer than that in EMR group(P<0.05).There was no significant difference in recovery time of gastrointestinal function or hospitalization time between the two groups(P>0.05).After surgery,levels of serum CA125and PGⅡin both groups were decreased.PGⅡlevel in ESD group was lower than that in EMR group(P<0.05).After surgery,PG I level was increased in both groups(P<0.05).PGⅠlevel in ESD group was higher than in EMR group(P<0.05).Within 6months after surgery,recurrence rate of gastric cancer in ESD group was lower than that in EMR group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).[Conclusion]The curative effect of ESD is significant on EGC.Compared with EMR,ESD can more completely excise cancer lesions,reduce level of serum CA125,regulate PG secretion,promote the recovery of gastric gland function and reduce recurrence risk of EGC.However,its operation is more complicated than EMR,and excised tissues are larger.The careful operation should be required to reduce the risks of bleeding and perforation.

关 键 词：早期胃癌 内镜黏膜下剥离术 糖类抗原-125 胃蛋白酶原 

分 类 号：R735.2[医药卫生—肿瘤]