内镜下黏膜剥离术治疗上消化道早期癌及癌前病变的临床疗效

Clinical effects of endoscopic submucosal dissection in the treatment of early upper gastrointestinal cancer and precancerous lesions

目的分析内镜下黏膜剥离术(ESD)在上消化道早期癌及癌前病变的治疗价值。方法选取74例上消化道早期癌及癌前病变患者作为研究对象,按手术方式分为ESD组(n=40)与内镜黏膜切除术(EMR)组(n=34),观察两组手术指标差异,比较术后并发症发生情况,随访1年,统计术后复发率,观察患者消化道功能的恢复情况及生活质量的改善状况。结果 (1)ESD组术中出血量少于EMR组,住院时间、创面愈合时间短于EMR组(P<0.05);(2)ESD组轻度疼痛所占比例(82.50%)高于EMR组,中重度疼痛所占比例(7.50%、0.00%)均低于EMR组(P<0.05);(3)ESD整体并发症发生率为5.00%,低于EMR组的32.35%(P<0.05),且其完整切除率高于EMR组(P<0.05);(4)术后3、12个月ESD组复发率(2.50%、5.00%)低于EMR组(8.82%、17.65%),但对比差异无统计学意义(P>0.05);(5)ESD组术后3、6、12个月生活质量评分均高于EMR组(P<0.05)。结论采用ESD治疗上消化道早期癌及癌前病变患者,手术完整切除率高,患者术后恢复快,并发症发生率低,复发少,术后生活质量高。

Objective To evaluate the value of endoscopic submucosal dissection（ESD） in the treatment of early upper gastrointestinal cancer and precancerous lesions. Methods Seventy-four patients with early upper gastrointestinal cancer and precancerous lesions were selected as the study subjects and were divided into ESD group（n = 40） and endoscopic mucosal resection（EMR） group（n = 34） according to the operation method. The differences in operation indexes between two groups were observed. The incidence of postoperative complications was compared. After one-year follow-up, the postoperative recurrence rate was statistically analyzed. The recovery of digestive tract function and the improvement of quality of life in patients were observed. Results①The intraoperative blood loss in ESD group was less than that in EMR group and the length of hospital stay and wound healing time was shorter than that of EMR group（P〈0.05）;② The proportion of mild pain in ESD group（82.50%） was higher than that in EMR group while the proportions of moderate and severe pain（7.50%,0） were lower than those in EMR group（P〈0.05）;③The overall incidence rate of complications in ESD group（5.00%） was lower than that in EMR group（32.35%）（P〈0.05） and the complete resection rate was higher than that in EMR group（P〈0.05）;④ 3 and 12 months after operation, the recurrence rates in ESD group（2.50%, 5.00%） were lower than those in EMR group（8.82%, 17.65%）（P〈0.05）;⑤3, 6, and 12 months after operation, the scores of quality of life in ESD group were higher than those in EMR group（P〈0.05）. Conclusion ESD is safe and effective in the treatment of early upper gastrointestinal cancer and precancerous lesions.