腹腔镜胃癌根治术和内镜黏膜下剥离术在早期胃癌患者中的应用效果比较

Comparison of the application effect of laparoscopic radical gastrectomy and endoscopic submucosal dissection in patients with early gastric cancer

目的 比较腹腔镜胃癌根治术(LRG)和内镜黏膜下剥离术(ESD)在早期胃癌患者中的应用效果。方法根据治疗方法的不同将96例早期胃癌患者分为ESD组(n=49,ESD治疗)和LRG组(n=47,LRG治疗),比较两组患者的围手术期指标、手术切除效果、疼痛程度[视觉模拟评分法(VAS)]、应激反应指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)、丙二醛(MDA)]、术后并发症发生情况及局部复发情况。结果 ESD组患者手术时间、首次排气时间、胃管拔除时间、术后进食恢复时间、住院时间及术后并发症总发生率均低于LRG组,术中出血量少于LRG组,差异均有统计学意义(P﹤0.05)。LRG组患者完整切除率、治愈性切除率均高于ESD组,差异均有统计学意义(P﹤0.05)。术后6 h、1天、3天、7天,两组患者VAS评分均低于本组术前,ESD组患者VAS评分均低于LRG组,差异均有统计学意义(P﹤0.05)。术后24 h,两组患者CRP、PCT、IL-6、TNF-α、MDA水平均高于本组术前,SOD水平均低于本组术前,ESD组患者CRP、PCT、IL-6、TNF-α、MDA水平均低于LRG组,SOD水平高于LRG组,差异均有统计学意义(P﹤0.05)。LRG组患者的局部复发率为2.13%,与ESD组患者的4.08%比较,差异无统计学意义(P﹥0.05)。结论 与LRG比较,虽然ESD手术切除效果稍差,但可满足手术治疗要求,并且手术时间更短、术中出血量更少、术后疼痛感和应激反应程度更轻、患者术后恢复更快、并发症发生率更低。

Objective To compare the application effect of laparoscopic radical gastrectomy(LRG)and endoscopic submucosal dissection(ESD)in patients with early gastric cancer.Method A total of 96 patients with early gastric can-cer were divided into ESD group(n=49,ESD treatment)and LRG group(n=47,LRG treatment)according to different treatment methods,and the perioperative indexes,surgical resection effect,degree of pain[visual analogue scale(VAS)],stress response indexes[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),superoxide dismutase(SOD),malondialdehyde(MDA)],incidence of postoperative complications and local re-currence were compared between the two groups.Result The operation time,first exhaust time,gastric tube removal time,postoperative feeding recovery time,hospital stay and total incidence of postoperative complications in ESD group were lower than those in LRG group,the intraoperative blood loss was lower than that in LRG group,and the differences were statistically significant(P<0.05).The complete resection rate and curative resection rate in LRG group were higher than those in ESD group,and the differences were statistically significant(P<0.05).At 6 h,1 day,3 days and 7 days after operation,the VAS scores in two groups were lower than those before operation,the VAS scores in ESD group were low-er than those in LRG group,and the differences were statistically significant(P<0.05).At 24 h after operation,the levels of CRP,PCT,IL-6,TNF-αand MDA in two groups were higher than those before operation,and the levels of SOD were lower than those before operation,the levels of CRP,PCT,IL-6,TNF-αand MDA in ESD group were lower than those in LRG group,the level of SOD in ESD group was higher than that in LRG group,and the differences were statistically sig-nificant(P<0.05).The local recurrence rate of patients in LRG group was 2.13%,compared with 4.08%in ESD group,the difference was not statistically significant(P>0.05).Conclusion Compared with LRG,although the effect of ESD surgical resection is slightly worse,it can meet the requirements of surgical treatment,and the operation time is shorter,the intraoperative blood loss is less,the degree of postoperative pain and stress reaction are lighter,the postoperative re-covery of patients is faster,the incidence of complications is lower.