内镜黏膜下剥离术治疗早期胃癌的临床效果观察

Efficacy of endoscopic submucosal dissection in the treatment of early gastric cancer

目的探讨内镜黏膜下剥离术治疗早期胃癌的临床效果。方法选取2013年1月至2016年7月间四川省彭州市人民医院收治的116例早期胃癌患者,采用随机数表法分为观察组和对照组,每组58例。观察组患者采用内镜黏膜下剥离术,对照组患者采用常规外科手术,观察两组患者癌肿一次性整块切除率、组织学治愈性切除率、术后溃疡愈合率、局部残留率及复发率,对所有患者行治疗后1年、2年和3年随访,比较两组患者生存率。结果观察组患者术中出血发生率和迟发性出血发生率为19.0%和0.0%,均低于对照组患者的39.7%和6.9%,差异均有统计学意义(均P<0.05)。观察组患者平均手术时间为(95.65±27.07)min,平均住院天数为(8.37±1.71)d,均短于对照组患者的(165.04±17.12)min和(12.75±1.81)d,差异均有统计学意义(均P<0.05)。观察组患者总并发症发生率为3.5%,低于对照组患者的22.4%,差异有统计学意义(P<0.05)。观察组患者治疗后2年和3年生存率分别为98.3%和87.9%,高于对照组患者的87.9%和74.1%,差异均有统计学意义(均P<0.05)。两组患者治疗后1年的生存率比较,差异无统计学意义(P>0.05)。结论内镜黏膜下剥离术是治疗早期胃癌安全有效的方法,手术效果、手术时间及术后并发症的发生率均优于常规外科手术,值得临床推荐。

Objective To explore the clinical efficacy of endoscopic submucosal dissection in the treatment of early gastric cancer. Methods A total of 116 patients with early gastric cancer treated at People＇s Hospital of Pengzhou from January 2013 to July 2016 were selected. Patients were divided into an observation group and a control group using a random number table with 58 patients in each group. The observation group underwent endoscopic submucosal dissection and the control group underwent the conventional surgery. The rate of one-time radical resection,histological resection rate,postoperative ulcer healing rate,local residual rate and recurrence rate were observed. One-year,2-year and 3-year survival rates were observed during the follow-up period. Results Perioperative bleeding rate and incidence of delayed hemorrhage was 19. 0% and 0. 0% respectively for the observation group which were lower than 39. 7% and6. 9% respectively of the control group（ all P〈0. 05）. The average operation time was（ 95. 65 ± 27. 07）min and the average length of hospital stay was（ 8. 37 ± 1. 71） d for observation group which was significantly lower than（ 165. 04 ± 17. 12） min and（ 12. 75 ± 1. 81） d respectively of the control group（ all P〈0. 05）. The overall incidence of complications was 3. 5% for the observation group which was lower than22. 4% of the control group（ P〈0. 05）. After the treatment,the 2-year and 3-year survival rate was98. 3% and 87. 9%,respectively for the observation group which was higher than 87. 9% and 74. 1%,respectively of the control group（ all P〈0. 05）. There was no significant difference in 1-year survival rate between the two groups（ P〈0. 05）. Conclusion Endoscopic submucosal dissection is a safe and effective method for the treatment of early gastric cancer. Its efficacy,operation time and postoperative complications are better than conventional surgery and is worthy of clinical popularization.