二氧化碳环境下内镜黏膜下剥离术治疗早期胃癌临床观察

Clinical Observation of Endoscopic Submucosal Dissection in Treatment of Patients with Early Gastric Cancer under CO_2 Environment

目的探讨二氧化碳(CO_2)环境下内镜黏膜下剥离术(ESD)对早期胃癌(EGC)患者预后的影响。方法选择2012年1月—2014年1月我院择期行ESD的EGC患者96例,随机分为CO_2组和空气组,每组48例,观察两组组织学疗效、手术及术后恢复情况、血气指标变化及术后并发症,平均随访16个月,记录两组复发情况。结果两组组织学疗效、手术时间、术后出血、纵隔气肿、皮下气肿发生率、术后血二氧化碳分压和血氧饱和度水平比较差异无统计学意义(P>0.05);CO_2组膈下游离气体深度小于空气组,进食时间、住院时间和气腹完全消失时间均较空气组短,术后穿孔发生率低于空气组(P<0.05,P<0.01)。CO_2组术后无一例复发。结论 ESD术中应用CO_2对血气指标无影响,且能够缩短术后恢复时间,降低穿孔发生率。

Objective To investigate effect of endoscopic submucosal dissection （ ESD） on prognosis of patients with early gastric cancer （ EGC） under carbon dioxide （ CO2 ） environment. Methods A total of 96 patients with EGC undergoing ESD between January 2012 and January 2014 were randomly divided into CO2 group （n=48） and air group （n=48）. In two groups, histological effect, intraoperative and postoperative conditions, changes of blood gas indexes before and after operation were observed, and recurrence rates were recorded with average 16 months of follow-up. Re-sults There were no significant differences in histological effect, operative time, incidence rates of postoperative bleed-ing, mediastinal emphysema and subcutaneous emphysema, postoperative PaCO2 and arterial oxygen saturation （ SpO2 ） levels in two groups （P〉0. 05）. Values of depth of subphrenic free air, dieting time, hospitalization time and pneumo-peritoneum completely disappearing time were lower, and postoperative incidence rate of perforation was lower in CO2 group than those in air group （P〈0. 05, P〈0. 01）. No recurrence was found in CO2 group. Conclusion CO2 in appli-cation of ESD proves to be of no effect on blood gas indexes, and it can reduce postoperative recovery time as well as inci-dence rate of perforation.