内镜黏膜下剥离术与内镜下黏膜切除术治疗早期食管癌的临床效果分析

Comparison of clinical effects of endoscopic submucosal dissection and endoscopic mucosal resection in the treatment of early esophageal cancer

目的比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗早期食管癌的临床疗效及对患者围术期指标、并发症和复发的影响。方法选取2019年4月至2020年4月十堰市人民医院消化内镜中心行内镜检查并诊断为早期食管癌的122例患者作为研究对象,按照手术方式的不同分为ESD组和EMR组,每组61例。比较两组患者临床疗效、围术期指标(手术时间、术中出血、住院时间)、术后并发症(穿孔、感染、腹腔脏器粘连)及复发情况。结果ESD组患者整块切除率、完全切除率均高于EMR组,术中出血量、手术时间均少于EMR组,术后穿孔发生率高于EMR组,复发率低于EMR组,差异有统计学意义(P<0.05);两组患者术后感染及腹腔脏器粘连发生率比较,差异无统计学意义(P>0.05)。结论早期食管癌患者的治疗优先考虑ESD,虽然术后穿孔是ESD最主要的并发症,但对病灶的切除更为彻底,手术时间及术中出血量更少。

Objective To compare endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early esophageal cancer and the effect on perioperative indices,complications,and recurrence.Methods From April 2019 to April 2020,122 patients diagnosed with early esophageal cancer underwent endoscopy in the Digestive Endoscopy Center of Shiyan People’s Hospital.The patients were divided into ESD and EMR groups with 61 patients in each group.Clinical efficacy,perioperative indices(operative time,intraoperative blood loss,and length of hospital stay),postoperative complications(perforation,infection,and abdominal organ adhesion),and the recurrence rate were compared between the two groups.Results The excision and complete excision rates in the ESD group were better than the EMR group(P<0.05).The intraoperative blood loss and operative time were lower in the ESD group than the EMR group.The incidence of postoperative perforation in the ESD group was higher than the EMR group,and the recurrence rate in the ESD group was lower than the EMR group(P<0.05).There was no significant difference in the incidence of postoperative infections and abdominal organ adhesions between the two groups(P>0.05).Conclusion ESD is the preferred treatment modality for patients with early esophageal cancer.Although postoperative perforation is the most common complication of ESD,it has a broad application prospect in the treatment of early esophageal cancer due to more thorough excision of lesions,less operative time,and less intraoperative bleeding.