侵犯黏膜下层早期食管癌行内镜黏膜下剥离术联合放疗的临床应用价值

Clinical Value of Endoscopic Submucosal Dissection Combined with Radiotherapy in Early Esophageal Cancer Invading Submucosa

目的分析ESD(内镜黏膜下剥离术)联合放疗治疗侵犯黏膜下层早期食管癌的临床疗效。方法选定四川省攀枝花市中心医院2017年11月—2019年11月收治的78例侵犯黏膜下层早期食管癌患者,以双盲随机抽样法分组(每组样本容量39例),参照组采纳EMR(内镜下黏膜切除术)联合放疗治疗,实验组采纳ESD联合放疗治疗,对比两组手术指标、整块切除率、完整切除率、并发症发生率、复发率、GQOLI-74评分。结果两组住院时间比较,P>0.05;实验组手术时间明显比参照组长,术中出血量明显比参照组低,实验组整块切除率、完整切除率(94.87%、89.74%)均明显比参照组(74.36%、66.67%)高,并发症发生率实验组(23.08%)明显比参照组(5.13%)高,实验组复发率(2.56%)明显比参照组(20.51%)低,实验组出院6个月后GQOLI-74评分明显比参照组高,差异均有统计学意义(P<0.05)。结论侵犯黏膜下层早期食管癌患者实施ESD联合放疗治疗,可有效缩短手术时间,提高病灶切除率,且复发率较低,患者生活质量明显提升,近远期疗效显著,但术后并发症较多,故临床医师应根据患者具体情况,选择最佳术式。

Objective To analyze the clinical efficacy of ESD(endoscopic submucosal dissection)combined with radiotherapy on early esophageal cancer invading submucosa.Methods 78 patients with early esophageal cancer who invaded submucosa from November 2017 to November 2019 in Panzhihua Central Hospital were selected and grouped by double-blind random sampling(39 samples in each group).The reference group adopted EMR(endoscopic Inferior mucosal resection)combined with radiotherapy treatment,the experimental group adopted ESD combined with radiotherapy treatment,surgical indicators,block resection rate,complete resection rate,complication rate,recurrence rate,GQOLI-74 score of the two groups were compared.Results Comparison of hospitalization time between the two groups,P>0.05;the operation time of the experimental group was significantly longer than that of the reference group,and the intraoperative blood loss was significantly lower than that of the reference group.The rate of complete resection and complete resection(94.87%,89.74%)in the experimental group were both significantly higher than that in the reference group(74.36%,66.67%),the incidence of complications in the experimental group(23.08%)was significantly higher than 5.13%in the reference group,the recurrence rate of the experimental group(2.56%)was significantly lower than 20.51%in the reference group.The GQOLI-74 score of the experimental group was significantly higher than that of the reference group after 6 months of discharge,P<0.05(all differences were statistically significant).Conclusion ESD combined with radiotherapy for patients with early-stage esophageal cancer that invades submucosa can effectively shorten the operation time and increase the resection rate of the lesion,and the recurrence rate is low.The quality of life of the patients is significantly improved.There are many complications after surgery,so clinicians should choose the best operation according to the specific situation of patients.