内镜黏膜下剥离术对早期胃癌患者的临床疗效分析

Clinical efficacy analysis of endoscopic submucosal dissection for patients with early gastric carcinoma

目的对早期胃癌患者施行内镜黏膜下剥离术,分析其临床效果。方法 56例早期胃癌患者,随机分为对照组和治疗组,每组28例。对照组患者采用常规D1+或D2式根治性手术进行治疗,治疗组患者采用内镜黏膜下剥离术进行治疗。比较两组患者手术时间、住院时间、术中出血量、并发症发生情况、术后复发情况,分析治疗组患者完整切除情况。结果治疗组患者手术时间(100.5±20.2)min、住院时间(5.8±2.3)d均短于对照组的(210.4±14.5)min、(14.5±2.1)d,术中出血量(25±10)ml少于对照组的(80±7)ml,差异具有统计学意义(P<0.05)。两组患者并发症发生情况、术后复发情况比较差异无统计学意义(P>0.05)。治疗组患者均能成功行内镜下切除,整块切除率为100.0%(28/28),但术后病理提示其中有2例基底部可见病灶侵犯,遂重新行补救性手术,治疗组组织学完整切除率为92.9%(26/28)。结论内镜黏膜下剥离术具有确切的临床疗效,与传统手术相比,手术时间、术中出血量及住院时间明显减少,创伤更小,恢复更快,作为早期胃癌的治疗方式值得临床推广。

Objective To analyze the clinical effect of endoscopic submucosal dissection for patients with early gastric carcinoma. Methods A total of 56 patients with early gastric carcinoma were randomly divided into control group and treatment group, 28 cases in each group. Patients in the control group were treated with conventional D1 ＋ or D2 radical surgery, patients in the treatment group were treated with endoscopic submucosal dissection. The operative time, length of stay, intraoperative blood loss, occurrence of complications and postoperative recurrence between the two groups were compared, the complete resection of patients in the treatment group were analyzed. Results The operative time and length of stay of the treatment group were（100.5±20.2） min and（5.8±2.3） d respectively, which were significantly shorter than（210.4±14.5） min and（14.5±2.1） d of the control group, the intraoperative blood loss of the treatment group was（25±10） ml, which was significantly less than（80±7） ml of the control group, the differences were statistically significant（P〈0.05）. There were no significant differences in the occurrence of complications and postoperative recurrence between the two groups（P〈0.05）. Patients in the treatment group were successfully resected by endoscopy, and the total resection rate was 100.0%（28/28）. However, postoperative pathological findings showed that 2 cases of them had basal lesion invasion, so they underwent remedial surgery again. The histological complete resection rate of the treatment group was 92.9%（26/28）. Conclusion Endoscopic submucosal dissection has a definite clinical effect. Compared with traditional surgery, the operative time, intraoperative blood loss and length of stay are significantly reduced, the trauma is smaller, the recovery is faster. As a treatment for early gastric carcinoma, it is worthy of clinical promotion.