超声内镜辅助内镜黏膜下切除术对食管癌前病变患者术后应激反应及血清鳞状上皮细胞癌抗原水平的影响

Effect of endoscopic ultrasongraphy-assisted endoscopic mucosal resection on postoperative stress response and serum squamous cell carcinoma antigen level in postoperative patients with esophageal precancerous lesion

目的探讨超声内镜辅助内镜黏膜下切除术(EMR)对食管癌前病变患者术后应激反应及血清鳞状上皮细胞癌抗原(SCC)水平的影响。方法前瞻性选取2015年11月至2017年6月收治的食管癌前病变患者76例,随机数字表法分为对照组(n=38)与研究组(n=38)。研究组采取超声内镜辅助EMR,对照组采取EMR。术后统计两组手术用时及流质饮食时间,术前及术后即刻血清应激反应指标(去甲肾上腺素、肾上腺素、醛固酮、血管紧张素Ⅱ及肾素)水平,血清肿瘤标志物[细胞角蛋白19血清片段21-1(CYFRA21-1)、肿瘤特异性生长因子(TSGF)]水平,SCC水平和术后第7天及1个月血清遗传学分子[细胞周期素E(Cyclin E)、转化生长因子-α(TGF-α)]水平。结果研究组手术用时及流质饮食时间较对照组少(P<0.05);术后两组血清去甲肾上腺素、肾上腺素、醛固酮、血管紧张素Ⅱ及肾素水平较术前增高,但研究组较对照组低(P<0.05);术后两组血清CYFRA21-1、TSGF水平较术前增高,但研究组较对照组低(P<0.05);术后两组血清SCC水平较术前降低,且研究组较对照组低(P<0.05);术后第7天及1个月研究组血清Cyclin E、TGF-α水平较对照组低(P<0.05)。结论采用超声内镜辅助内镜黏膜下切除术治疗食管癌前病变,可缩短手术用时及流质饮食时间,降低血清鳞状上皮细胞癌抗原水平,应激反应及对机体造成的损伤程度较轻,利于降低血清肿瘤标志物及遗传学分子水平。

Objective To investigate the effect of endoscopic ultrasongraphy-assisted endoscopic mucosal resection（ EMR） on postoperative stress response and serum squamous cell carcinoma antigen（ SCC） level in postoperative patients with esophageal precancerous lesion. Methods 76 patients with esophageal precancerous lesion in our hospital from November 2015 to June 2017 were selected and randomly divided into the control group（ n = 38） and the study group（ n = 38）. The study group was treated with endoscopic ultrasongraphy-assisted EMR,and the control group was treated with EMR. The operative time,liquid diet time,preoperative and poatoperative immediate serum stress response index（ norepinephrine,epinephrine,aldosterone,angiotensin and renin） level,serum tumor markers [Cytokeratin 19,serum fragment 21-1（ CYFRA21-1）,tumor specific growth factor（ TSGF） ] levels and tumor specific growth factor（ TSGF）〗 level,the SCC levels and serum genetic molecules at 7 d and 1 month after surgery [cyclin E（ Cyclin E） and transforming growth factor-α（ TGF-α） ] levels were counted. Results The operation time and fluid diet time in the study group were less than those in the control group（ P〈0. 05）. The levels of norepinephrine,epinephrine,aldosterone,angiotensin II and renin in the two groups were higher than those before operation,but the study group was lower than the control group（ P〈0. 05）. The levels of serum CYFRA21-1 and TSGF in the two groups were higher than those before operation,but the study group was lower than the control group（ P〈0. 05）. The level of serum SCC in two groups was lower than that before operation,and the study group was lower than that of the control group（ P〈0. 05）. The serum levels of Cyclin,E and TGF-in the study group were lower than those in the control group at seventh day and 1 month after operation（ P〈0. 05）. Conclusion Using endoscopic ultrasongraphy-assisted EMR to treat patients with esophageal precancerous lesion can reduce the operation time and feeding time,reduce the antigen levels of serum squamous cell carcinoma. The stress reaction and the degree of damage to the body are lighter. It is helpful to reduce the leakage of tumor markers and genetic molecular.