内镜下黏膜切除术与内镜黏膜下剥离术治疗上消化道早期癌的效果比较

Comparison of the effects of endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of early cancer of upper digestive tract

目的 比较内镜下黏膜切除术(EMR)与内镜黏膜下剥离术(ESD)治疗上消化道早期癌的效果。方法 选择2019年1月至2020年12月我院收治的56例上消化道早期癌患者为研究对象,根据手术方式不同将其分为对照组(28例,EMR)和试验组(28例,ESD)。比较两组的治疗效果。结果 试验组的手术时间长于对照组(P<0.05);两组的术中出血量、术中穿孔率、≤20 mm病灶完全切除率、整块切除率、复发率比较,差异无统计学意义(P>0.05)。术后24 h,试验组的轻度疼痛占比高于对照组(P<0.05)。术后1周,两组的血管内皮生长因子A(VEGFA)、血管内皮生长因子B(VEGFB)、血管内皮生长因子C(VEGFC)、嗜铬粒蛋白A(CgA)水平均较术前降低,且试验组低于对照组(P<0.05)。试验组的并发症总发生率低于对照组(P<0.05)。术后6个月,两组的社会功能、认知功能、躯体功能、角色功能、情绪功能评分均较术前升高,且试验组高于对照组(P<0.05)。结论 EMR和ESD均在上消化道早期癌治疗中有一定效果,但后者效果更显著,能减轻患者疼痛,降低VEGFA、VEGFB、VEGFC、CgA水平,且并发症较少,利于患者早日康复。

Objective To compare the effects of endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) in the treatment of early cancer of upper digestive tract. Methods Fifty-six patients with early cancer of upper digestive tract admitted in our hospital from January 2019 to December 2020 were selected as the research objects,and the patients were divided into control group(28 cases, EMR) and experimental group(28 cases, ESD) according to different surgical methods. The therapeutic effects of the two groups were compared. Results The operation time of the experimental group was longer than that of the control group(P<0.05);there were no significant differences in intraoperative blood loss, intraoperative perforation rate, complete resection rate of lesions ≤ 20 mm, en bloc resection rate and recurrence rate between the two groups(P>0.05). At 24 h after operation, the proportion of mild pain in the experimental group was higher than that in the control group(P <0.05). One week after operation, the levels of vascular endothelial growth factor A(VEGFA), vascular endothelial growth factor B(VEGFB), vascular endothelial growth factor C(VEGFC) and chromogranin A(CgA) in the two groups were lower than those before operation, and those in the experimental group were lower than the control group(P<0.05). The total incidence of complications in the experimental group was lower than that in the control group(P <0.05). At 6 months after operation, the scores of social function, cognitive function, physical function, role function and emotional function in the two groups were higher than those before operation, and those in the experimental group were higher than the control group(P<0.05). Conclusion Both EMR and ESD have certain effects in the treatment of early cancer of upper digestive tract, but the latter is more effective, which can reduce the pain of patients,reduce the levels of VEGFA, VEGFB, VEGFC and CgA, and have fewer complications, which is conducive to the early recovery of patients.