内镜黏膜下剥离术与内镜下黏膜切除术治疗早期食管癌的临床效果分析

Analysis of Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Early Esophageal Cancer

目的探讨内镜黏膜下剥离术(ESD)与内镜下黏膜切除术(EMR)在早期食管癌治疗中的应用效果。方法选取78例早期食管癌患者,按随机数字表法分为2组,各39例。对照组予以EMR治疗,观察组予以ESD治疗。术后随访6个月。比较2组手术情况、病灶切除率、肿瘤标志物、生活质量及并发症。结果观察组手术时间[(73.58±6.25)min]长于对照组,术中出血量[(89.63±6.12)mL]少于对照组,差异有统计学意义(P<0.05);观察组整块切除率(89.74%)、完全切除率(79.49%)高于对照组(71.79%、56.41%),差异有统计学意义(P<0.05)。观察组术后鳞状细胞癌抗原(SCCA)[(3.15±0.42)μg/L]、癌胚抗原(CEA)[(6.89±1.13)μg/L]及细胞角蛋白19血清片段21-1(CYFRA21-1)[(2.89±0.38)μg/L]水平较对照组低,有统计学差异(P<0.05)。观察组术后生活质量中生理领域评分[(87.63±7.15)分]、心理领域评分[(86.59±6.78)分]、社会领域评分[(88.57±6.58)分]及环境领域评分[(90.41±5.21)分]高于对照组,有统计学差异(P<0.05)。观察组术后穿孔发生率较对照组高,有统计学差异(P<0.05)。结论ESD在早期食管癌中的治疗效果优于EMR,能够提高病灶整块切除率、完全切除率,加快肿瘤标志物水平下降,改善术后患者生活质量,但术后穿孔风险较高。

Objective To investigate the application effect of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early esophageal cancer.Methods 78 patients with early esophageal cancer were divided into 2 groups and 39 patients each.The control group was treated with EMR,and the observation group was treated with ESD and followed up for 6 months after surgery.The surgical conditions,lesion resection rate,tumor markers,quality of life,and complications were compared between the 2 groups.Results The operation time[(73.58±6.25)min]was longer than that in the control group,Intraoperative bleeding volume[(89.63±6.12)mL]was less than that in the control group,The difference was statistically significant(P<0.05);The total resection rate(89.74%)and complete resection rate(79.49%)were higher than those in the control group(71.79%,56.41%),The difference was statistically significant(P<0.05);In the observation group,postoperative squamous cell carcinoma antigen(SCCA)[(3.15±0.42)μg/L],carcinoembryonic antigen(CEA)[(6.89±1.13)μg/L]and cytokeratin 19 serum fragments 21-1(CYFRA21-1),1[(2.89±0.38)μg/L]were lower than in the control group,Statistical difference(P<0.05);In the observation group,the physiological domain score[(87.63±7.15)],psychological domain score[(86.59±6.78)],social domain score[(88.57±6.58)]and environmental domain score[(90.41±5.21)]were higher than that of the control group,Statistical difference(P<0.05);The incidence of postoperative perforation was higher in the observed group compared with the control group,Statistical difference(P<0.05).Conclusion The therapeutic effect of ESD in early esophageal cancer is better than EMR,which can improve the overall resection rate,accelerate the level reduction rate of tumor markers,and improve the postoperative quality of life,but the risk of postoperative perforation is higher.