ESD与传统手术治疗早期胃癌的疗效及对术后免疫应激反应和远期生存率的影响

Effects of ESD and traditional surgery on postoperative immumological stress response and long-term survival in patients with early gastric cancer

目的探讨内镜黏膜下剥离术(ESD)与传统手术治疗早期胃癌的疗效及对术后免疫应激反应和远期生存率的影响。方法回顾性分析90例早期胃癌患者的临床资料,根据手术方式的不同将患者分为ESD组(n=45)和传统手术组(n=45),比较两组患者的临床疗效、围手术期情况、术前和术后的免疫指标、术后并发症发生率、3年生存率和3年局部复发率。结果 ESD组和传统手术组患者的总有效率分别为86.67%(39/45)和88.89%(40/45),差异无统计学意义(P﹥0.05)。ESD组患者的手术时间、禁食禁水时间、胃肠减压时间和住院时间均明显短于传统手术组(P﹤0.01);术后两组患者的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和C反应蛋白(CRP)水平均高于本组术前(P﹤0.05),术后ESD组患者的血清TNF-α、IL-6、CRP水平均明显低于传统手术组(P﹤0.01)。术后ESD组患者的并发症总发生率为8.89%(4/45),低于传统手术组的26.67%(12/45),差异有统计学意义(P﹤0.05);ESD组和传统手术组患者的3年生存率分别为93.33%(42/45)和91.11%(41/45),3年局部复发率分别为6.67%(3/45)和8.89%(4/45),差异均无统计学意义(P﹥0.05)。结论 ESD和传统手术治疗早期胃癌的疗效相当,均可获得良好的病灶切除效果,远期生存率高,但与传统手术相比,ESD造成的免疫应激反应更轻,术后并发症更少,患者恢复更快,安全性更高,值得应用推广。

Objective To study the effects of endoscopic submucosal dissection （ESD） and traditional surgery on postoperative immunological stress response and long-term survival in patients with early gastric cancer.Method Clinical data from 90 patients with early gastric cancer were analyzed retrospectively. According to different methods of operation, the patients were divided into the ESD group （n=45） and the traditional operation group （n=45）, the clinical efficacy, perioperative condition, immune indexes before and after treatment, postoperative complications, 3-year survival rate and 3-year local recurrence rate of the two groups were compared.Result The total effective rates of the two groups were 86.67% （39/45） and 88.89% （40/45）, respectively, and the difference was not statistically significant （P〉0.05）. The operative time, fasting time, gastrointestinal decompression time and hospital stay in the ESD group were significantly shorter than those in traditional operation group （P〈0.01）; after treatment, the serum levels of tumor necrosis factor-α （TNF-α, interleukin -6 （IL-6） and C reactive protein （CRP） in two groups were all significantly higher than those before the treatment in each group （P〈0.05）, but the TNF-α, IL-6 and CRP in the ESD group were significantly lower than those in the traditional operation group （P〈0.01）. The total incidence of complications in the ESD group was 8.89% （4/45）, which was significantly lower than that of 26.67% （12/45） in the traditional operation group （P〈0.05）; the 3-year survival rate in the E SD group and the traditional operation group were 93.33% （42/45） and 91.11% （41/45） respectively, the 3-year local recurrence rate were 6.67% （3/45） and 8.89% （4/45） respectively, the differences were not statistically significant （P〉 0.05）. Conclusion The efficacies of ESD and traditional operation in treatment for patients with early gastric cancer are similar, with good results of excision and high long-term survival rate. And compared with traditional operation, the ESD induces lighter immumological stress response and less complications, bring to the patients faster recovery and higher safety, which is worthy of application.