内镜黏膜下剥离术与内镜黏膜切除术对Ⅰ、Ⅱ期胃癌患者血清肿瘤标志物水平及并发症的影响

Effects of Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection on Serum Tumor Markers and Complications in Patients with StageⅠandⅡGastric Cancer

目的:探讨内镜黏膜下剥离术与内镜黏膜切除术对Ⅰ、Ⅱ期胃癌患者血清肿瘤标志物水平及并发症的影响。方法:选取苏州市第九人民医院2016年1月-2021年12月收治的102例Ⅰ、Ⅱ期胃癌患者,通过随机数字表法分为观察组和对照组,各51例。观察组行内镜黏膜下剥离术治疗,对照组给予内镜黏膜切除术治疗。比较两组术中出血量、手术时间及住院时间,比较两组治疗前后肿瘤标志物水平[采用酶联免疫吸附试验法检测糖类抗原19-9(CA19-9)及糖类抗原72-4(CA72-4)水平],统计两组随访5个月期间皮下气肿、出血、腹痛的发生情况。结果:观察组术中出血量少于对照组,住院时间和手术时间均短于对照组(P<0.05)。术前两组CA19-9、CA72-4水平比较,差异均无统计学意义(P>0.05);术后观察组CA19-9、CA72-4水平均低于对照组,差异均有统计学意义(P<0.05)。随访5个月,观察组术后有出血、皮下气肿、腹痛各1例,对照组有4例皮下气肿,3例出血和5例腹痛,观察组并发症发生率(5.88%)低于对照组(23.53%),差异有统计学意义(P<0.05)。结论:与内镜黏膜切除术相比,内镜黏膜下剥离术治疗Ⅰ、Ⅱ期胃癌可减少术中出血量,缩短手术时间及住院时间,降低血清肿瘤标志物水平和并发症发生率,值得进一步在临床中推广应用。

Objective:To investigate the effects of endoscopic submucosal dissection and endoscopic mucosal resection on serum tumor markers and complications in patients with stageⅠ,Ⅱgastric cancer.Method:A total of 102 patients with stageⅠ,Ⅱgastric cancer who were admitted to the Suzhou Ninth People's Hospital from January 2016 to December 2021 were selected and divided into an observation group and a control group according to the random number table,with 51 cases in each group.The observation group was treated with endoscopic submucosal dissection,and the control group was treated with endoscopic mucosal resection.The amount of intraoperative bleeding,operation time and hospitalization time were compared between the two groups,and the levels of tumor markers[the levels of carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 72-4(CA72-4)were detected by enzyme-linked immunosorbent assay]before and after treatment were compared between the two groups,and the occurrence of subcutaneous emphysema,bleeding and abdominal pain during the five-month follow-up period was counted in the two groups.Result:The amount of intraoperative bleeding in the observation group was less than that in the control group,and the hospitalization time and operation time were shorter than those in the control group(P<0.05).There were no significant differences in the levels of CA19-9 and CA72-4 between the two groups before operation(P>0.05).The levels of CA19-9 and CA72-4 in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).After five-months follow-up,there were 1 case of bleeding,1 case of subcutaneous emphysema and 1 case of abdominal pain in the observation group,and there were 4 cases of subcutaneous emphysema,3 cases of bleeding and 5 cases of abdominal pain in the control group,the incidence of complications in the observation group(5.88%)was lower than that in the control group(23.53%),the difference was statistically significant(P<0.05).Conclusion:Compared with endoscopic mucosal resection,endoscopic submucosal dissection can reduce the amount of intraoperative bleeding,shorten the operation time and hospitalization time,and reduce the level of serum tumor markers and the incidence of complications,which is worthy of further clinical application.