ESD在消化道早癌患者中的疗效观察及对生存质量的影响研究

Efficacy of ESD in Patients with Early Digestive Tract Cancer and Its Effect on Life Quality

目的探讨内镜黏膜下剥离术(ESD)在消化道早癌患者中的临床效果及对生存质量的影响。方法选择2014年1月-2016年8月收治的消化道早癌患者60例作为研究对象,所有患者均行ESD手术治疗,术后3 d评估患者效果,术后对患者进行24个月随访。记录患者手术时间、术中出血量、术后进食、排气及住院总时间;采用QLO-C30生存质量量表对患者手术前、手术后3 d的躯体、角色、情绪、认知功能及总体状况进行评估;记录患者术后出血、食管反流、切口感染、狭窄发生率;统计两组术后生存期,比较两组临床疗效及对生存质量的影响。结果所有患者均顺利完成手术,手术成功率为100.00%。患者手术时间(67.46±5.61) min、术中出血量(175.39±15.32) ml、术后进食时间(2.14±0.12) d、排气时间(4.38±0.87) h及住院总时间(5.98±1.21) d。患者手术后生存质量得到不同程度升高,但手术前、手术后3 d的躯体、角色、情绪、认知功能及总体状况评分差异有统计学意义(P<0.05);患者手术后出血1例、食管反流0例、切口感染0例,狭窄1例;术后对患者进行5年随访,患者1年生存率为100.00%; 2年生存率为96.67%(58/60)。结论将ESD用于消化道早癌患者中手术创伤较小,能提高患者生存质量,术后并发症发生率较低,有助于提高患者生存期,值得推广应用。

Objective To investigate the clinical effects of endoscopic submucosal dissection （ESD） in patients with earlydigestive tract cancer and its impact on quality of life. Methods Sixty patients with early-stage gastrointestinal cancer who wereadmitted between January 2014 and August 2016 were enrolled. All the patients underwent ESD surgery. They were evaluated 3days after surgery, and followed up for 24 months. The patients ＇ duration of surgery, intraoperative blood loss, postoperativefeeding, exhaust and total hospital stay were recorded. The body, role, mood, cognitive function and overall status were observedbefore surgery and 3 days after surgery using the QLO-C30 scale of quality of life. The patients＇ quality of life assessment wascompleted, the incidence of postoperative bleeding, esophageal reflux, wound infection and stenosis were recorded, the survivaltime of the two groups was compared, and the clinical efficacy and quality of life of the two groups were compared. Results All thepatients successfully completed operations with a success rate of 100. 00%. Among these patients, the duration of surgery was（67. 46±5. 61） min, the intraoperative blood loss （175. 39±15. 32） ml, the postoperative feeding time （2. 14±0. 12） d, the exhaust time （4. 38±0. 87） h and the total hospital stay （5. 98±1. 21） d. The quality of life of patients after surgery improved todifferent extents, and there were significant differences in the body, role, mood, cognitive function and overall status scores before surgery and 3 days after it （P〉0. 05）. One patient had postoperative bleeding. There were no esophageal reflux or incisioninfection, but there was one case of stenosis. After 5 years of follow-up, the one-year survival rate was 100. 00%while the two-year survival rate was 96. 67% （58 / 60）. Conclusion ESD, when used in patients with digestive tract early cancer, can causeless surgical trauma, improve the quality of life of patients, and result in lower incidence of postoperative complications, whichcan help to improve the survival of patients. It is worthy of popularization and application.