内镜黏膜切除术与内镜黏膜下剥离术治疗早期胃癌的效果比较  

Comparison of therapeutic effect of endoscopic mucosal resection and endoscopic submucosal dissection on early gastric cancer

作　　者：杨磊[1] 石小红 张学秀[2] 张英[1] 王冬梅[1] 赵丽辉[1] Yang Lei;Shi Xiaohong;Zhang Xuexiu;Zhang Ying;Wang Dongmei;Zhao Lihui(Gastrointestinal Endoscopy Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院消化内镜中心,郑州450000 [2]郑州大学第一附属医院消化内科,郑州450000

出　　处：《中国实用医刊》2023年第17期9-12,共4页Chinese Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目计划 (20A320054)。

摘　　要：目的:探讨内镜黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)治疗早期胃癌的效果。方法:抽取2019年1月至2022年1月郑州大学第一附属医院收治的早期胃癌患者200例,根据手术方式分为对照组(50例)与观察组(150例)。对照组采用EMR治疗,观察组采用ESD治疗。比较两组肿瘤切除率、手术指标[手术时间、手术出血量、病灶切除面积、术后视觉模拟评分法(VAS)评分、住院时间]、并发症及术后1年复发率。比较两组手术前后胃蛋白酶原(PG)水平。结果:观察组大块切除率、完全切除率、治愈性切除率均高于对照组(P均<0.05)。与对照组比较,观察组手术时间更长,但住院时间更短,手术出血量更少,病灶切除面积更大,术后VAS评分更低(P<0.05)。术后,观察组PGⅠ水平高于对照组,PGⅡ水平低于对照组,差异有统计学意义(P<0.05)。两组并发症发生率、术后1年复发率比较差异未见统计学意义(P>0.05)。结论:与EMR相比,采取ESD治疗早期胃癌,虽然手术时间更长,但可以减少手术出血量,增加肿瘤切除范围,提高病灶切除率,同时可缩短住院时间,减轻术后疼痛,更好地改善术后PG水平,不会明显增加并发症与复发风险。Objective To investigate the effect of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in the treatment of early gastric cancer.Methods A total of 200 patients with early gastric cancer treated in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2022 were selected and divided into control group(50 cases)and observation group(150 cases)according to surgical methods.The control group was treated by EMR,and the observation group was treated by ESD.The tumor resection rate,surgical indexes,including operation time,intraoperative blood loss,area of lesion resection,postoperative visual analogue scale(VAS)score and hospital stay,incidence of complications,and 1-year postoperative recurrence rate were compared between the two groups.The levels of pepsinogen(PG)of the two groups were compared before and after treatment.Results The massive resection rate,complete resection rate and curative resection rate of the observation group were higher than those of the control group(all P<0.05).Compared with control group,the observation group had longer operation time,shorter hospital stay,less intraoperative blood loss,larger area of lesion resection,and lower postoperative VAS score(P<0.05).After operation,the observation group had higher level of PGⅠand lower level of PGⅡ,compared with the control group(P<0.05).There was no significant difference between the two groups in the incidence of complications and 1-year postoperative recurrence rate(P>0.05).Conclusions Compared with EMR,ESD in the treatment of early gastric cancer have longer operation time,but it can reduce surgical bleeding,increase the scope of tumor resection,improve the resection rate of the lesion,shorten the hospital stay,reduce postoperative pain,better improve the level of postoperative PG,and will not significantly increase the risk of complications and recurrence.

关 键 词：胃癌 内镜黏膜切除术 内镜黏膜下剥离术 胃蛋白酶原 生活质量 肿瘤切除率 

分 类 号：R735.2[医药卫生—肿瘤]