内镜黏膜切除术和内镜黏膜下剥离术对早期胃癌及癌前病变患者胃蛋白酶原和生活质量的影响

Effect of endoscopic mucosal resection and endoscopic submucosal dissection on pepsinogen and quality of life in patients with early gastric cancer and precancerous lesion

目的 探讨内镜黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)对早期胃癌及癌前病变患者胃蛋白酶原和生活质量的影响。方法 根据手术方式的不同将92例早期胃癌及癌前病变患者分为EMR组(n=46)和ESD组(n=46)。比较两组患者的病变切除情况、手术相关指标、胃蛋白酶原Ⅰ(PGⅠ)水平、胃蛋白酶原Ⅱ(PGⅡ)水平、PGⅠ/PGⅡ、并发症发生情况、术后复发情况及生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]。结果 ESD组患者病变整块切除率、治愈性切除率均高于EMR组,基底病灶残余率低于EMR组,差异均有统计学意义(P﹤0.05)。ESD组患者术中出血量明显多于EMR组,手术时间、住院时间均明显长于EMR组,差异均有统计学意义(P﹤0.01)。术后7天,两组患者的PGⅠ水平及PGⅠ/PGⅡ均高于本组术前,PGⅡ水平均低于本组术前,ESD组患者的PGⅠ水平及PGⅠ/PGⅡ均高于EMR组,PGⅡ水平低于EMR组,差异均有统计学意义(P﹤0.05)。ESD组患者的并发症总发生率和术后1年复发率均低于EMR组(P﹤0.05)。术后3个月、6个月、1年,ESD组患者的EORTC QLQ-C30评分均明显高于EMR组,差异均有统计学意义(P﹤0.01)。结论 与EMR相比,ESD治疗早期胃癌及癌前病变患者可有效切除病灶,降低术后并发症发生率及术后复发率,改善生活质量,并促进胃黏膜功能恢复,改善胃蛋白酶原水平,但ESD对病灶的切除范围较大,患者住院时间较长。

Objective To investigate the effect of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)on pepsinogen and quality of life in patients with early gastric cancer and precancerous lesion.Method A total of 92 patients with early gastric cancer and precancerous lesion were divided into EMR group(n=46)and ESD group(n=46)according to different surgical methods.The lesion resection,surgery-related indicators,pepsinogen I(PG I)level,pepsinogen II(PG II)level,PG I/PG II,complications,postoperative recurrence,and quality of life[European Organization for Research and Treatment of Cancer quality of life questionnaire core 30(EORTC QLQ-C30)]were compared between the two groups.Result The en-bloc resection rate and curative resection rate in the ESD group were higher than those in the EMR group,and the residual rate of basal lesions was lower than that in the EMR group,and the differences were statistically significant(P<0.05).The intraoperative blood loss in the ESD group was significantly more than that in the EMR group,and the operation time and hospital stay were significantly longer than those in the EMR group,and the differences were statistically significant(P<0.01).Seven days after the operation,the levels of PG I and PG I/PG II in the two groups were higher than those before the operation,and the levels of PG II were lower than those before the operation,the levels of PG I and PG I/PG II in the ESD group were higher than those in the EMR group,and the level of PG II was lower than that in the EMR group,and the differences were statistically significant(P<0.05).The total incidence of complications and one-year recurrence rate in the ESD group were lower than those in the EMR group(P<0.05).At three months,six months,and one year after the operation,the EORTC QLQ-C30 scores in the ESD group were significantly higher than those in the EMR group,and the differences were statistically significant(P<0.01).Conclusion ESD could effectively remove lesions in patients with early gastric cancer and precancerous lesion,reduce the incidence of complications and postoperative recurrence rate,improve the quality of life,promote the recovery of gastric mucosal function,and improve the level of pepsinogen compared with EMR.However,the lesions resected by ESD is relatively large,and the hospital stay of patients is longer.