内镜粘膜切除术和食管切除术治疗早期食管粘膜内腺癌的疗效对比研究

The Comparison between Endoscopic Mucosal Resection and Esophagectomy for Early Esophageal Intramucosal Adenocarcinoma

目的比较内镜粘膜切除术和食管切除术治疗早期食管粘膜腺癌的疗效。方法以病理诊断为早期食管腺癌的患者作为研究对象,随机对患者采取内镜粘膜切除术或食管切除术进行治疗。比较两组患者的疾病资料和手术相关指标。结果采用内镜下黏膜切除术的患者有36例,采用食管切除术的患者有30例,两组患者在年龄、性别、体质指数、肿瘤浸润深度、肿瘤细胞分化程度、Barrett食管长度占比和术后复发例数上无明显的统计学差异(P>0.05),但住院时间<2周的例数内镜粘膜切除组较食管切除术组多,并且在手术时间、术中出血量和术后并发生率方面均优于食管切除术组,手术方式和术后不同时期并不是影响患者短期内生存质量的因素。结论内镜粘膜切除术在治疗早期食管腺癌上具有手术时长短和手术并发症少的优点,并且不会对患者短期的生活质量造成明显影响。

Objective To compare the surgical effects and safety between endoscopic mucosal resection and esophagectomy for early esophageal intramucosal adenocarcinoma. Methods Patients diagnosed as early esophageal intramucosal adenocarcinoma were recruited. Patients were randomly divided into 2 groups according to their operation method. The disease information and surgical related index were compared between the 2 groups. The influencing factors of quality of life after surgery in the short term were also analyzed. Results 36 patients received endoscopic mucosal resection and 30 patients received esophagectomy.There were no differences in age,sex,body mass index,tumor invasion depth,tumor cellular differentiation degree,Barrett esophagus length and cases of postoperative recurrence between the 2 groups（ P 0. 05）. However,the number of patients whose length of stay in hospital was less than 2 weeks in endoscopic mucosal resection group was more than that of esophagectomy group. Besides,the endoscopic mucosal resection group patients also had shorter operation duration,less intraoperative blood loss and smaller numbers of postoperative complications. Operation method and different time points after operation were not the influencing factors of quality of life for patients with early esophageal intramucosal adenocarcinoma in the short term. Conclusion Endoscopic mucosal resection has the advantage of short operation duration and few postoperative complications. It has no impact on quality of life for patients with early esophageal intramucosal adenocarcinoma in the short term.