腹腔镜下胃癌根治术和内镜黏膜下剥离术治疗早期胃癌合并冠心病患者的效果比较  

Comparison of the efficacy of laparoscopic radical gastrectomy and endoscopic submucosal dissection in the treatment of patients with early gastric cancer complicated with coronary heart disease

作　　者：朱琳[1] 张毅 ZHU Lin;ZHANG Yi(Endoscopy Center,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,He’nan,China)

机构地区：[1]南阳医学高等专科学校第一附属医院内镜中心,河南南阳4730000

出　　处：《癌症进展》2024年第13期1504-1508,共5页Oncology Progress

摘　　要：目的比较腹腔镜下胃癌根治术(LRG)和内镜黏膜下剥离术(ESD)治疗早期胃癌合并冠心病患者的效果。方法根据治疗方式的不同将98例早期胃癌合并冠心病患者分为LRG组(n=47,LRG治疗)和ESD组(n=51,ESD治疗),比较两组患者的围手术期指标、疼痛情况[视觉模拟评分法(VAS)]、心功能指标[肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白(ⅠcTnⅠ)、左室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]、应激反应指标[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、肾上腺素(EP)]以及术后心脏并发症发生情况。结果ESD组患者手术时间、首次排气时间、胃管拔除时间、进食恢复时间、住院时间均短于LRG组,术中出血量少于LRG组,术后心脏并发症总发生率低于LRG组,差异均有统计学意义(P﹤0.05)。术后6 h、1天、3天、7天,两组患者VAS评分均低于本组术前,ESD组患者VAS评分均低于LGR组,差异均有统计学意义(P﹤0.05)。术后12 h,两组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均高于本组术前,LRG组患者LVEF、CI、CO均低于本组术前,ESD组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均低于LRG组,LVEF、CI、CO均高于LRG组,差异均有统计学意义(P﹤0.05)。结论与LRG比较,ESD治疗早期胃癌合并冠心病患者的安全性高、手术时间短、术中出血量少、手术创伤小、术后疼痛程度轻,因此患者术后应激反应更轻,对患者心功能的不良影响更小,术后恢复更快。Objective To compare the efficacy of laparoscopic radical gastrectomy(LRG)and endoscopic submucosal dissection(ESD)in the treatment of patients with early gastric cancer complicated with coronary heart disease.Method A total of 98 patients with early gastric cancer complicated with coronary heart disease were divided into LRG group(n=47,LRG treatment)and ESD group(n=51,ESD treatment)according to different treatment methods,and the perioperative period indexes,pain conditions[visual analogue scale(VAS)],cardiac function indexes[creatine kinase isoenzyme-MB(CK-MB),cardiac troponinⅠ(cTnⅠ),left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac output(CO)],stress response indexes[high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),cortisol(Cor),adrenocorticotropic hormone(ACTH),epinephrine(EP)]and incidence of postoperative cardiac complications of the two groups were compared.Result The surgery time,first exhaust time,gastric tube removal time,feeding recovery time and hospital stay in ESD group were shorter than those in LRG group,the intraoperative blood loss was less than that in LRG group,and the total incidence of postoperative cardiac complications was lower than that in LRG group,and the differences were statistically significant(P<0.05).At 6 h,1 day,3 days and 7 days after surgery,the VAS scores in two groups were lower than those before surgery,the VAS scores in ESD group were lower than those in LGR group,and the differences were statistically significant(P<0.05).At 12 h after surgery,the CK-MB,cTnⅠ,hs-CRP,TNF-α,IL-6,Cor,ACTH and EP in two groups were higher than those before surgery,the LVEF,CI and CO in LRG group were lower than those before surgery,the CK-MB,cTnⅠ,hs-CRP,TNF-α,IL-6,Cor,ACTH and EP in ESD group were lower than those in LRG group,the LVEF,CI and CO were higher than those in LRG group,and the differences were statistically significant(P<0.05).Conclusion Compared with LRG,ESD in the treatment of patients with early gastric can

关 键 词：早期胃癌 冠心病 腹腔镜下胃癌根治术 内镜黏膜下剥离术 效果 

分 类 号：R735.2[医药卫生—肿瘤]