内镜黏膜下剥离术与外科手术治疗早期胃癌的临床研究

Clinical efficacy of endoscopic submucosal dissection and surgical treatment for early gastric cancer

目的:比较内镜黏膜下剥离术(ESD)与外科手术治疗早期胃癌的临床疗效。方法:回顾性选取80例早期胃癌患者,按治疗方式分为ESD组和外科手术组,各40例。对2组患者的病灶切除率、手术时间、住院时间、医疗费用、术后并发症等进行比较。结果:2组病灶治愈性切除率均为100%(P>0.05)。ESD组与外科手术组比较,平均手术时间(89.3 min vs 215.4 min,P<0.05),平均住院时间(10.5 d vs 22.5 d,P<0.05),平均医疗费用(1.79万元vs5.93万元,P<0.05)均明显减少。ESD组术后并发胃食管反流1例,感染1例(肺部感染),幽门狭窄1例,出血1例,总发生率10.0%;外科手术组术后并发胃食管反流7例,感染5例(肺部感染1例,创口感染4例),胃、十二指肠吻合口狭窄2例,出血6例,总发生率50.0%,明显高于ESD组(P<0.05)。结论:内镜黏膜下剥离术治疗早期胃癌疗效确切,手术和住院时间短,医疗费用少,术后并发症发生率低。

Objective：To observe the clinical efficacy of endoscopic submucosal dissection （ESD） and surgical treat- ment for early gastric cancer. Methods ： Eighty patients with early gastric cancer were selected. All of the patients were divid- ed into ESD group and surgery group, according to the different treatment methods. The resection rate, operation time, length of hospital stay, medical cost and postoperative complications were compared between the two groups. Results ： The resection rate in both groups was 100.0%. The average operative time in ESD group and surgery group was 89.3 and 215.4 rain （ P 〈 0.05 ）, the average hospital stay was 10.5 and 22.5 days （ P 〈 0. 05 ）, the average medical cost was 1.79 × 104 and 5.93 × 104 yuan RMB （ P 〈 0.05 ）, respectively. There was 1 case of gastroesophageal reflux, 1 case of infection, 1 case of stenosis and 1 case of bleeding in the ESD group, and the total incidence rate was 10.0% （4/40）. There were 7 cases of gastroesophageal reflux, 5 cases of infection, 2 cases of stenosis and 6 cases of bleeding in the surgery group, and the total incidence rate was 50.0% （20/40）. There was significant difference between two groups. Conclusion： ESD in the treatment of early gastric cancer is effective, and has the advantages of shorter operation time and hospital stay, less medical expenses, and lower incidence of postoperative complications.