内镜黏膜下剥离术和内镜黏膜切除术治疗早期胃癌和癌前病变的疗效以及对血清胃蛋白酶原的影响

Efficacy of endoscopic mucosal dissection versus endoscopic mucosal resection for treatment of early gastric cancer and precancerous lesions and their effects on serum pepsinogen

目的比较内镜黏膜下剥离术(ESD)和内镜黏膜切除术(EMR)治疗早期胃癌及癌前病变的疗效以及对血清胃蛋白酶原(PG)的影响。方法选取早期胃癌或癌前病变患者124例,随机分为ESD组与EMR组各62例,采用相应术式进行治疗。另选取62例健康体检者为对照组。比较ESD组和EMR组病变切除情况、术中出血量、手术时间、住院时间、手术并发症发生、复发率及术后1年、3年生存情况;比较ESD组、EMR组及对照组血清PGⅠ、PGⅡ水平以及PGⅠ/PGⅡ比值。结果ESD组治愈性切除率、整块切除率均高于EMR组,手术时间、住院时间均长于EMR组,术中出血量多于EMR组(均P<0.05)。术后7 d,ESD、EMR组PGⅠ水平和PGⅠ/PGⅡ比值均较术前升高,PGⅡ水平较术前降低(均P<0.05);与对照组和ESD组术后水平比较,EMR术后PGⅠ水平和PGⅠ/PGⅡ比值降低,而PGⅡ水平升高(均P<0.05),但ESD组术后以上指标与对照组比较差异无统计学意义(均P>0.05)。ESD组并发症发生率、复发率均低于EMR组,术后3年生存者比例大于EMR组(P<0.05)。结论与EMR相比,ESD可更有效地切除早期胃癌及癌前病变,促进胃部细胞及腺体功能恢复,纠正PG异常分泌,降低并发症发生率及复发率。

Objective To compare the efficacy between endoscopic mucosal dissection(ESD)and endoscopic mucosal resection(EMR)for the treatment of early gastric cancer and precancerous lesions as well as their effects on serum pepsinogen(PG).Methods A total of 124 patients with early gastric cancer or precancerous lesions were enrolled and randomly divided into ESD group(n=62)and EMR group(n=62),and the two groups were treated with corresponding procedures.Another 62 healthy check-up individuals were enrolled as control group.The condition of lesions removed,intraoperative blood loss,operation duration,hospital stay,incidence of complications related to surgery,recurrence rate,and postoperative 1-and 3-year survival were compared between the ESD and EMR groups.Serum PGⅠand PGⅡ levels as well as PGⅠ/PGⅡ ratio were compared among the ESD group,the EMR group and the control group.Results The ESD group had higher curative resection rate and en bloc resection rate,longer operation duration and hospital stay,and more intraoperative blood loss in contrast to the EMR group(all P<0.05).Seven days after operation,PGⅠlevel and PGⅠ/PGⅡ ratio were increased and PGⅡ level was decreased in the ESD and EMR groups as compared with the levels before treatment(all P<0.05);compared with the control group and postoperative levels in the ESD group,decreased PGⅠ level and PGⅠ/PGⅡ ratio as well as increased PGⅡ level were observed in the EMR group after operation(all P<0.05),however,there was no statistically significant difference in the indices mentioned above after operation between the ESD group and the control group(all P>0.05).The ESD group reported lower incidence rate of complications and recurrence rate,greater proportion of survivors three years postoperatively as compared with the EMR group(P<0.05).Conclusion Compared with EMR,ESD can contribute to effective resection of early gastric cancer and precancerous lesions,promote the recovery of gastric cell and gland function,correct the abnormal secretion of PG,and reduce incidence rate of complications and recurrence rate.