内镜黏膜下剥离术治疗早期胃癌的疗效及对预后的影响

Efficacy and prognosis of endoscopic submucosal dissection in the treatment of early gastric cancer

目的 探讨内镜黏膜下剥离术治疗早期胃癌的疗效及对预后的影响。方法 将80例早期胃癌患者按照手术方式的不同分为开腹手术组和内镜剥离术组,每组40例。比较两组患者的围手术期指标、手术前后的胃肠道动力激素和胃蛋白酶原水平、并发症发生情况以及预后情况。结果 内镜剥离术组患者手术时间、术后胃肠通气时间、术后进食时间、住院时间均明显短于开腹手术组,术中出血量明显少于开腹手术组,差异均有统计学意义(P﹤0.01)。手术后,内镜剥离术组患者血管活性肠肽、胃蛋白酶原Ⅱ水平均低于开腹手术组,胃动素、胃蛋白酶原Ⅰ水平均高于开腹手术组,差异均有统计学意义(P﹤0.05)。内镜剥离术组患者并发症总发生率明显低于开腹手术组,差异有统计学意义(P﹤0.01)。术后1年和术后2年,两组患者生存情况和复发情况比较,差异均无统计学意义(P﹥0.05)。结论 早期胃癌患者采用内镜黏膜下剥离术可有效改善围手术期指标和胃肠功能,减少术后并发症,疗效确切且预后较好。

Objective To investigate the efficacy and prognosis of endoscopic submucosal dissection in the treatment of early gastric cancer.Method A total of 80 patients with early gastric cancer were divided into laparotomy group and endoscopic dissection group according to different surgical methods,with 40 cases in each group.The perioperative indicators,the levels of gastrointestinal motility hormone and pepsinogen,the occurrence of complications,and the prognosis were compared between the two groups.Result The operation time,postoperative gastrointestinal ventilation time,postoperative eating time,and hospitalization time of patients in the endoscopic dissection group were significantly shorter than those in the laparotomy group,and the intraoperative blood loss was significantly less than that in the laparotomy group,and the differences were statistically significant(P<0.01).After the surgery,the levels of vasoactive intestinal peptide and pepsinogen Ⅱ in the endoscopic dissection group were lower than those in the laparotomy group,and the levels of motilin and pepsinogen Ⅰ were higher than those in the laparotomy group,and the differences were statistically significant(P<0.05).The total incidence of complications in the endoscopic dissection group was significantly lower than that in the laparotomy group,and the difference was statistically significant(P<0.01).There were no significant differences in survival and recurrence between the two groups at one year and two years after the operation(P>0.05).Conclusion Endoscopic submucosal dissection for patients with early gastric cancer could effectively improve perioperative indicators and gastrointestinal function,reduce postoperative complications,and has a reliable curative effect with a better prognosis.