内镜下黏膜剥离术治疗老年人胃早期肿瘤的风险性及安全性研究

Risk and safety of endoscopic submucosal dissection in the treatment of early gastric tumors in the elderly

目的评价内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)对老年人胃早期肿瘤治疗效果及安全性研究。方法回顾性收集2010-2019年武汉大学人民医院确诊为内镜下可切除胃早期肿瘤的患者150例,将其分为老年组(年龄≥65岁)70例和非老年组(年龄<65岁)80例。分别从病灶切除复发率、围手术期指标、生活质量等几方面进行评估。结果整块切除率老年组为94.3%(66/70),非老年组为92.5%(74/80),完整切除率老年组为92.9%(65/70),非老年组为88.8%(71/80),治愈性切除率老年组为90.0%(63/70),非老年组为88.8%(71/80)。术后迟发性出血老年组为2.9%(2/70),非老年组为1.3%(1/80)。术中穿孔老年组为1.4%(1/70),非老年组为0(0/80)。感染率老年组为2.9%(2/70),非老年组均为1.3%(1/80)。术后3个月、6个月及12个月的病灶切除复发率在老年组与非老年组间差异无统计学意义(P>0.05)。生存质量测定量表简表中生理、心理、社会及环境领域评分显示,老年组与非老年组在术后6个月与术前6个月相比有显著的提高(P<0.05)。结论ESD对治疗老年人胃早期肿瘤是一种安全有效的治疗方法。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD)in the treatment of early gastric tumors in elderly patients.Methods A retrospective collection of 150 patients diagnosed with endoscopically resectable early gastric tumors at Renmin Hospital of Wuhan University from 2010 to 2019 was conducted.The patients were divided into elderly group(≥65 years old)with 70 cases and non-elderly group(<65 years)with 80 cases.The evaluation was performed in terms of lesion resection recurrence rate,perioperative surgical indicators,and quality of life.Results The total resection rate was 94.3%(66/70)in the elderly group and 92.9%(74/80)in the non-elderly group.The complete resection rate was 92.5%(65/70)in the elderly group and 88.8%(71/80)in the non-elderly group.The curative resection rate was 90.0%(63/70)in the elderly group and 88.8%(71/80)in the non-elderly group.The incidence of delayed postoperative bleeding was 2.9%(2/70)in the elderly group and 1.3%(1/80)in the non-elderly group.The incidence of intraoperative perforation was 1.4%(1/70)in the elderly group and 0(0/80)in the non-elderly group.The infection rate was 2.9%(2/70)in the elderly group and 1.3%(1/80)in the non-elderly group.There was no statistically significant difference in the recurrence rate of lesion resection at 3 months,6 months,and 12 months between the elderly and non-elderly groups.The scores in the World Health Organization Quality of Life-BREF(WHOQOL-BREF)questionnaire showed significant improvement in the physiological,psychological,social,and environmental domains in both the elderly group and non-elderly group at 6 months postoperatively compared with 6 months before surgery(P<0.05).Conclusion ESD is a safe and effective method for the treatment of early gastric tumors in elderly patients.