ESD与EMR治疗早期胃癌的疗效及安全性分析  

Analysis of the efficacy and safety of ESD and EMR in the treatment of early gastric cancer

作　　者：程媚霖 杨敬端[1] Cheng Meilin;Yang Jingduan(Department of Gastroenterology,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院消化内科,南阳473000

出　　处：《国际医药卫生导报》2023年第23期3370-3374,共5页International Medicine and Health Guidance News

基　　金：河南省医学科技攻关项目(LHGJ202100321)。

摘　　要：目的观察内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)及内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗早期胃癌对血清肿瘤标志物表达的影响,及不同术式与不良预后发生率的相关性。方法回顾性分析2020年5月至2021年4月南阳医学高等专科学校第一附属医院收治的110例早期胃癌患者为研究对象,根据治疗方式不同,将采用ESD治疗的60例患者列为ESD组[男35例、女25例,年龄(50.33±5.31)岁],采用EMR治疗的50例患者列为EMR组[男30例、女20例,年龄(51.25±5.17)岁]。对比两组患者治疗情况及预后情况,并经Spearman相关性系数检验不同治疗方式与早期胃癌不良预后发生率的相关性。计量资料采用t检验,计数资料采用χ^(2)检验。结果ESD组病灶完整切除率[91.67%(55/60)]、治愈性切除率[83.33%(50/60)]均高于EMR组[70.00%(35/50)、60.00%(30/50)],非治愈性切除率[8.33%(5/60)]低于EMR组[30.00%(15/50)],差异均有统计学意义(χ^(2)=15.156、9.630、15.156,均P<0.05)。术前,两组患者血清肿瘤标志物比较,差异均无统计学意义(均P>0.05);术后,ESD组癌胚抗原(carcinoembryonic antigen,CEA)[(6.41±2.11)μg/L]、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)[(37.22±5.18)U/ml]、糖类抗原724(carbohydrate antigen 724,CA724)[(35.12±5.47)U/ml]均低于EMR组[(8.24±3.13)μg/L、(40.16±5.33)U/ml、(38.44±5.63)U/ml],差异均有统计学意义(t=3.644、2.925、3.128,均P<0.05)。ESD组术后1年病情复发率为10.00%(6/60)、病死率为6.67%(4/60),均低于EMR组[24.00%(12/50)、18.00%(9/50)],术后2年病情复发率为16.67%(10/60)、病死率为11.67%(7/60),均低于EMR组[32.00%(16/50)、24.00%(12/50)],差异均有统计学意义(χ^(2)=6.945、5.936、6.382、5.187,均P<0.05)。经Spearman相关性系数检验,ESD与早期胃癌不良预后发生率呈负相关(r=-0.155、-0.147,均P<0.001),EMR与早期胃癌不良预后发生率呈正相关(r=0.254、0.251,均P<0.001)。结论与EMR相比,对早期胃Objective To observe the effects of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)on the expression of serum tumor markers in early gastric cancer,and the correlation between different surgical procedures and the incidence of adverse prognosis.Methods This study conducted a retrospective analysis on 110 patients with early gastric cancer admitted to the First Affiliated Hospital of Nanyang Medical College from May 2020 to April 2021.According to different treatment methods,60 patients who underwent ESD surgery were classified as the ESD group[35 males and 25 females,aged(50.33±5.31)years],and 50 patients who underwent EMR surgery were classified as the EMR group[30 males and 20 females,aged(51.25±5.17)years].The treatment and prognosis of the two groups were compared.The correlation between different treatment methods and the incidence of adverse prognosis in early gastric cancer was tested by Spearman correlation coefficient.t test was used for the measurement data and χ^(2) test was used for the count data.Results Under different surgical protocols,the complete resection rate[91.67%(55/60)]and curative resection rate[83.33%(50/60)]of lesions in the ESD group were higher than those in the EMR group[70.00%(35/50)and 60.00%(30/50)],and the non-curative resection rate[8.33%(5/60)]was lower than that in the EMR group[30.00%(15/50)],with statistically significant differences(χ^(2)=15.156,9.630,and 15.156;all P<0.05).Before surgery,there were no statistically significant differences in the serum tumor markers between the two groups(all P>0.05).After surgery,the levels of carcinoembryonic antigen(CEA)[(6.41±2.11)μg/L],carbohydrate antigen 19-9(CA19-9)[(37.22±5.18)U/ml],carbohydrate antigen 724(CA724)[(35.12±5.47)U/ml]in the ESD group were lower than those in the EMR group[(8.24±3.13)μg/L,(40.16±5.33)U/ml,and(38.44±5.63)U/ml],with statistically significant differences(t=3.644,2.925,and 3.128;all P<0.05).The postoperative 1-year recurrence rate and mortality rate of the ESD group w

关 键 词：内镜下黏膜剥离术 内镜下黏膜切除术 早期胃癌 肿瘤标志物 不良预后 

分 类 号：R735.2[医药卫生—肿瘤]