内镜黏膜下剥离术在早期大肠癌及癌前病变的临床研究

Clinical Research on Endoscopic Submucosal Dissection in Treating Early Colorectal Cancer and Precancerous Lesion

目的研究内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)在早期大肠癌及其癌前病变的临床效果。方法选择2011年7月至2013年6月于成都医学院第一附属医院接受治疗的早期大肠癌及其癌前病变患者86例,依照随机数字表法分为ESD组(n=45)与对照组(n=41),ESD组行ESD治疗,对照组行开腹术治疗。观察两组手术时间、住院费用及住院时间,整块完整切除和治愈性切除情况,术前及术后7dCD3+、CD4+和CD8+等T淋巴细胞水平,TNF-α、CRP和IL-6等炎性因子水平,术后并发症及预后情况等。结果 ESD组手术时间、住院费用和住院时间均低于对照组,差异有统计学意义(P<0.05)。ESD组整块完整切除率(93.33%)与对照组(100.00%)差异无统计学意义(P<0.05);两组治愈性切除率均为100.00%。术后7d,ESD组CD3+、CD4+水平较对照组高,CD8+水平较对照组低,差异有统计学意义(P<0.05)。术后7d,ESD组TNF-α、CRP和IL-6水平较对照组低,差异有统计学意义(P<0.05)。ESD组术后并发症发生率(4.44%)较对照组(31.71%)低,差异有统计学意义(P<0.05)。两组患者术后3年期间未见病灶复发及转移病例。结论 ESD治疗早期大肠癌及其癌前病变疗效显著,手术效率高,术后并发症发生率低,具有较高的临床应用价值。

Objective To investigate the clinical effect of endoscopic submucosal dissection （ESD）in treating early colorectal cancer and precancerous lesion.Methods A total of 86 patients with early colorectal cancers or precancerous lesions treated in The First Affiliated hospital of Chengdu Medical College from July of 2011 to June of 2013 was selected and divided into the ESD group （n=45）and control group（n=41）in accordance with the random number table.The patients in the ESD group were given the ESD treatment,while those in the control group were treated with the open surgery. The observation was made between the two groups in the operation time, hospitalization expenses,hospital stays,the en bloc excision and curative resection,the levels of the T lymphocytes such as CD3^＋,CD4^＋,CD8＋,etc.before operatation and 7 days after operatation,the levels of the inflammatory factors such as TNF-a,CRP,IL-6,etc.,and the postoperative complications and prognosis.Results The operation time,hospitalization expenses and hospital stays in the ESD group were significantly less than those in the the control group （P〈0.05）.The en bloc resection rate of the ESD group （93.33%）was not significantly different from that of the control group （100%）,and the curative resection rates of both groups were 100%.The levels of CD3^＋ and CD4^＋ in the ESD group were significantly higher than those in the control group 7 days after operation （P〈0.05）,while the level of CD8＋ was significantly lower than that of the control group （P〈0.05）.The levels of TNF-α,CRP and IL-6 in the ESD group were significantly lower than those in the control group 7 days after operation （P〈0.05 ）.The incidence rate of the postoperative complications in the ESD group （4.44%）was significantly lower than that in the control group （31.71%）（P〈0.05）.There were no cases of focus recurrence or metastasis in the patients of both groups.Conclusion ESD has significant curative effect in treating early colorectal cancer and precancerous lesion,the efficiency of operation is high,and the incidence rate of the postoperative complications is low,so the therapy has high value of clinical application.