内镜辅助胃癌黏膜下剥离术治疗胃癌前病变及早期胃癌效果分析

Study on the efficacy of endoscopy assisted gastric mucosa stripping in treatment of gastric precancerous lesions and early gastric cancer

目的探讨内镜辅助胃癌黏膜下剥离术治疗胃癌前病变及早期胃癌的临床疗效。方法回顾分析2013年5月至2016年5月收治的胃癌前病变及早期胃癌患者共120例,其中100例患者行内镜辅助胃癌黏膜下剥离术,20例患者行外科手术切除术。对比观察两组的手术时间、术中出血情况,统计内镜辅助胃癌黏膜下剥离术组患者病灶一次切除成功率和整块切除率,同时随访观察两组患者术后有无消化道症状以及内镜下表现。结果 120例患者中共100例患者行内镜辅助胃癌黏膜下剥离术,共切除病灶100处,完整切除率为98.0%。内镜辅助胃癌黏膜下剥离术组手术时间(89.5±14.8 min)明显短于外科切除术组(214.6±46.5 min),差异有显著性(P<0.05)。外科切除术组患者术中出血率(10.0%)和手术治愈率(100.0%)与内镜辅助胃癌黏膜下剥离术组(10.0%、99.0%)相比,差异无显著性(P>0.05)。内镜辅助胃癌黏膜下剥离术组后1个月出现消化道症状阳性率为23.0%,而外科切除术组为80.0%,差异有显著性(P<0.05)。外科切除术组患者术后复发率为0,而内镜辅助胃癌黏膜下剥离术组术后复发率为1.0%,差异无显著性(P>0.05)。结论内镜辅助胃癌黏膜下剥离术治疗胃癌前病变及早期胃癌可以缩短手术时间,减少术中出血情况,完全剥离病变组织,减少术后并发症,术后复发风险小,提高患者生存质量。

Objective To explore the clinical efficacy of endoscopy assisted gastric mucosa stripping in treatment of gastric precancerous lesions and early gastric cancer.Methods A total of 120 patients with gastric precancerous lesion and early gastric cancer during May 2013 to May 2016 were enrolled in this study.Among them,100 patients underwent endoscopy assisted gastric mucosal dissection and 20 patients underwent surgical resection.The operating time,amount of intraoperative bleeding,successful rate,monolithic resection rate,gastrointestinal symptoms and endoscopic manifestations were observed in patients of these 2 groups after operation.Results One hundred of 120 patients underwent endoscopic assisted gastric mucosal dissection,the successful rate of primary resection was 97.0%and the rate of whole resection was 98.0%(P<0.05).The operating time was 89.5±14.8 min in endoscopic group and 214.6±46.5 min in surgical resection group(P<0.05).The operating time of patients in surgical resection group was significantly longer than that of endoscopic group.Their bleeding rate and cure rate were 10.0%and 100.0%respectively,and they were 10%and 99.0%respectively in endoscopic asasisted group,and they were 19.0%and 100%in surgical resection group.There was no significantly statistical difference between these two groups(P>0.05).The positive rate of gastrointestinal symptoms was 23.0%in 1 month after endoscopic gastric mucosal dissection,and 80%in patients underwent surgical resection.There was significant difference between these two groups(P<0.05).The recurrence rate was 0 in the surgical resection group,and the recurrence rate in another group was 1.0%.There was no significant difference between these two groups(P>0.05).Conclusion Endoscopy assisted gastric mucosa stripping can shorten the operating time,reduce the amount of bleeding,completely stripping the diseased tissue,reduce the postoperative complications,decrease the risk of recurrence and improve the quality of life of patients.