内镜黏膜下剥离术与外科手术治疗残胃异时性早期癌的临床效益对比

Comparison between endoscopic submucosal dissection and gastrectomy in clinical benefit for metachronous early gastric cancer in the remnant stomach

目的回顾性对比残胃异时性早期癌(metachronous early gastric cancer,MEGC)的组织病理特征及不同治疗方式的疗效。方法收集2014年1月至2020年12月鼓楼医院的残胃MEGC患者资料66例,按治疗方案分为内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)组38例和外科手术组28例,分析比较2组的基线特征、病理特征、治疗效果及费用差异。结果66例残胃MEGC患者年龄(69.7±8.5)岁,多为男性,残胃时间平均6年。肿瘤位置,ESD组以胃体(31.6%)为主,外科手术组以贲门为主(53.6%),差异存在统计学意义(χ^(2)=11.070,P=0.028)。平均手术时间、住院时间、术后禁食时间以及合计医疗费,ESD组分别为80.0 min、6.0 d、1.5 d、19436元,外科手术组分别为215.0 min、19.0 d、6.5 d、68665元,组间差异均有统计学意义(P<0.05)。随访期间生存率,ESD组76.3%,外科手术组71.4%,组间差异无统计学意义(χ^(2)=0.736,P=0.778)。并发症方面,ESD组出血7.9%、感染5.3%,外科手术组梗阻、感染均为14.3%,术后梗阻在组间差异有统计学意义(P<0.05)。结论ESD治疗残胃异时性癌安全有效,且在治疗费用和时间消耗方面优于外科手术,但其长期疗效仍需大样本前瞻性临床研究结果验证。

Objective To compare the histopathological features and treatment efficacy of different methods for metachronous early gastric cancer(MEGC)in the remnant stomach.Methods A total of 66 patients[38 endoscopic submucosal dissection(ESD)and 28 gastrectomy]with MEGC in the remnant stomach from January 2014 to December 2020 in Drum Tower Hospital were divided into the ESD group and the gastrectomy group.The baseline characteristics,histopathological features,treatment efficacy,and cost differences of the two groups were analyzed.Results The MEGC in the remnant stomach mostly occurred in elderly male patients,with the mean age of 69.7±8.5 years.The mean interval of the occurrence of MEGC in the remnant stomach was 6 years.As for the tumor location,the gastric body(31.6%)was the main location in the ESD group and gastric cardia(53.6%)in the gastrectomy group with significant difference(χ^(2)=11.07,P=0.026).The mean operation time,hospital stay,postoperative fasting time,and total treatment cost were 80.0 min,6.0 d,1.5 d,¥19436 in the ESD group and 215.0 min,19.0 d,6.5 d,and¥68665 in the gastrectomy group,respectively,with significant differences between the two groups(P<0.05).The overall survival rate during follow-up was 76.3%in the ESD group and 71.4%in the gastrectomy group with no significant difference between the two groups(χ^(2)=0.736,P=0.778).In terms of postoperative complications,the incidences of bleeding and infection were 7.9%and 5.3%in the ESD group,and those of obstruction and infection were both 14.3%in the gastrectomy group.There was significant difference in the incidences of postoperative obstruction between the two groups(P<0.05).Conclusion ESD is safe and effective for MEGC in the remnant stomach and is better than gastrectomy in terms of the treatment cost and operation time,but the long-term efficacy still needs to be validated by large-scale prospective studies.