内镜黏膜下剥离术治疗上消化道间质瘤的疗效、出血量及并发症影响分析

Analysis of the Effect of Endoscopic Submucosal Dissection in the Treatment of Upper Gastrointestinal Stromal Tumor, Blood Loss and Complications

目的:探讨内镜黏膜下剥离术(ESD)治疗上消化道间质瘤的临床疗效,对出血量及并发症的影响。方法:随机抽取2018年4月—2019年4月河南省直第三人民医院进行治疗的28例上消化道间质瘤患者作为研究对象,所有患者均给予ESD治疗,分析患者治疗后总有效率,临床指标,主要包括手术时间、出血量、住院时间,术后并发症发生情况,手术前后免疫功能、围术期生理应激指标情况。结果:患者创面出血量在100mL以下,手术时间在30~100min以内。患者手术后治愈18例、显效6例、有效4例、治疗总有效率为100%。患者住院时间最短6d、最长12d,平均住院时间(9.00±3.00)d。发生出血并发症患者3例、穿孔患者2例、吞吐困难1例,并发症发生率为14.29%,经针对性干预后,患者并发症均消失。与术前相比,手术后第5d,患者CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、血清去甲肾上腺素(NE)水平、血清中皮质醇(Cor)无明显变化,差异无统计学意义(t=1.771、1.719、1.076、1.013、0.958、1.537,P>0.05)。结论:对上消化道间质瘤患者应用ESD手术治疗疗效显著,患者创面出血量较少,手术并发症少,且不会对其免疫功能造成较大影响,生理应激反应小。

Objective:To investigate the clinical efficacy of endoscopic submucosal dissection(ESD)in the treatment of upper gastrointestinal stromal tumors,and its influence on the amount of bleeding and complications.Methods:Twenty-eight patients with upper gastrointestinal stromal tumors who were treated in the hospital from April 2018 to April 2019 were randomly selected as the research subjects.All patients were given ESD.The total effective rate and clinical indicators of the patients after treatment were analyzed,including operation time,blood loss,hospital stay,postoperative complications,immune function before and after surgery,and perioperative physiological stress indicators.Results:The bleeding volume of the patients’wound was less than 100mL,and the operation time was within 30-100 min.Among the 28 patients,18 cases were cured after operation,6 cases showed obvious effect,4 cases were effective,and the total effective rate of the patients was 100%.The shortest hospital stay was 6 d and the longest was 12 d.The average hospital stay was(9.00±3.00)d.Among the 28 patients,there were 3 cases of bleeding complications,2 cases of perforation,and 1 case of dysphagia,with a complication rate of 14.29%.After targeted intervention,all the complications disappeared.Compared with before operation,on the 5th d after operation,there were no significant changes in CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),serum norepinephrine(NE)levels,and serum cortisol(Cor),and the difference was not statistically significant(t=1.771,1.719,1.076,1.013,0.958,1.537,P>0.05).Conclusion:ESD is effective in the treatment of upper gastrointestinal stromal tumors,with less wound bleeding,less surgical complications,no great impact on their immune function and less physiological stress response.