内镜黏膜下剥离术治疗早期贲门癌的疗效分析及对患者预后的影响

The efficacy analysis of endoscopic submucosal dissection in the treatment of early cardiac cancer and its impact on the prognosis of patients

目的探讨采取内镜黏膜下剥离术(ESD)用于早期贲门癌治疗的效果及对预后影响。方法选择2019年1月-2022年5月收治的84例早期贲门癌患者,随机分成观察组(n=42)、对照组(n=42)。对照组患者采取开放手术治疗,观察组患者采取ESD手术治疗。针对患者的各围术期指标、近远期疗效进行评价。结果观察组患者的手术时间(71.15±6.12)min长于对照组(56.25±5.41)min,差异有统计学意义(P<0.05);观察组患者术中出血量、术后正常进食时间、住院时间与对照组比较,均无显著差异(P>0.05)。两组患者的病灶完全切除率差异无统计学意义(P>0.05),观察组患者治愈性切除率为92.86%,明显高于对照组,观察组患者基底切缘阳性率为2.38%、侧切缘阳性率为4.76%,均低于对照组,组间差异均有统计学意义(P<0.05)。观察组远期随访率92.86%,平均随访时间(17.25±1.52)个月。对照组远期随访率90.48%,平均随访时间(17.11±1.48)个月。观察组追加手术率5.13%、远处转移率0均明显低于对照组(P<0.05),两组总体死亡率无显著差异(P>0.05)。结论针对早期贲门癌患者,采取开放手术与ESD手术治疗方式均可取得一定的效果,应用ESD虽然手术时间较长,但是在近远期疗效及预后上更佳,因此可作为首选的治疗方式。

Objective To explore the effect of endoscopic submucosal dissection(ESD)in the treatment of early cardiac cancer and its impact on the prognosis.Methods 84 patients with early cardiac cancer admitted from January 2019 to May 2022 were selected and randomly divided into observation group(n=42)and control group(n=42).The control group was treated with open surgery,and the observation group was treated with ESD.The perioperative indicators and short-term and long-term efficacy of the patients were evaluated.Results The operation time of the observation group was(71.15±6.12)min,which was longer than that of the control group(56.25±5.41)min,with statistically significant difference(P<0.05).There was no significant difference in intraoperative blood loss,postoperative normal feeding time and hospitalization time of the observation group(P>0.05).There was no statistically significant difference in the complete resection rate of the lesions between the two groups(P>0.05).The curative resection rate of the observation group was 92.86%,which was significantly higher than that of the control group.The positive rate of basal resection margin and lateral resection margin in the observation group was 2.38%and 4.76%,which were lower than those in the control group,with statistically significant differences between the two groups(P<0.05).The long-term follow-up rate of the observation group was 92.86%,and the average follow-up time was(17.25±1.52)months.The long-term follow-up rate of the control group was 90.48%,and the average follow-up time was(17.11±1.48)months.The additional surgery rate of the observation group was 5.13%,and the distant metastasis rate was 0.These rates were significantly lower than those of the control group(P<0.05).There was no significant difference in the overall mortality rate between the two groups(P>0.05).Conclusion For patients with early cardiac cancer,both open surgery and ESD surgery can achieve certain effects.Although the operation time of ESD is longer,it is more effective in short-term and long-term efficacy and prognosis,so it can be used as the preferred treatment.