摘要
目的探讨内镜下黏膜剥离术(ESD)在食管早癌中的应用效果.方法选取山东第一医科大学附属山东省立医院2020年1月—2021年9月收治的82例食管早癌患者,按随机数字表法分为两组,各41例.对照组采取内镜下黏膜切除术(EMR)治疗,观察组采取ESD治疗,均于术后随访1年.比较两组手术情况、病灶切除情况、肿瘤标志物水平、生活质量、复发率及并发症.结果观察组手术时间为(68.58±5.47)min,长于对照组的(42.49±4.47)min,术中出血量为(89.63±6.12)mL,少于对照组的(106.54±7.89)mL,组间差异有统计学意义(P<0.05).观察组整块切除率、完全切除率分别为87.80%、80.49%,均高于对照组的68.29%、58.54%,组间差异有统计学意义(P<0.05).术后7 d,观察组癌胚抗原、鳞状细胞癌抗原及细胞角蛋白19血清片段21-1水平分别为(6.89±1.13)μg/L、(3.15±0.42)μg/L、(2.89±0.38)μg/L,均低于对照组的(8.14±1.25)μg/L、(4.08±0.46)μg/L、(3.87±0.42)μg/L,组间差异有统计学意义(P<0.05).术后6个月,观察组世界卫生组织生活简易量表中生理、心理、社会及环境领域评分分别为(87.63±6.25)分、(86.59±6.58)分、(88.57±5.58)分、(90.41±4.21)分,均高于对照组的(79.31±6.16)分、(78.04±6.32)分、(80.41±6.32)分、(83.47±6.18)分,组间差异有统计学意义(P<0.05).观察组复发率为4.88%,低于对照组的19.51%,穿孔发生率为21.95%,高于对照组的4.88%,组间差异有统计学意义(P<0.05).结论ESD治疗食管早癌效果更佳,可减少术中出血量,提高病灶整块及完全切除率,降低肿瘤标志物水平及远期复发风险,但手术用时较长,且存在较高穿孔风险.
Objective To investigate the effect of endoscopic submucosal dissection(ESD)in early esophageal cancer.Methods 82 patients with early esophageal cancer admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2020 to September 2021 were selected and divided into two groups according to random number table method,with 41 cases in each group.The control group was treated with endoscopic mucosal resection(EMR)and the observation group was treated with ESD.All patients were followed up for 1 year.The surgical conditions,lesion resection,tumor markers,quality of life,recurrence rate and complications were compared between the two groups.Results The operation time of the observation group was(68.58±5.47)min,longer than(42.49±4.47)min of the control group,the intraoperative blood loss was(89.63±6.12)mL,less than(106.54±7.89)mL of the control group,and the differences between the groups were statistically significant(P<0.05).The whole resection rate and complete resection rate in the observation group were 87.80%and 80.49%,respectively,which were higher than 68.29%and 58.54%in the control group,and the differences between groups were statistically significant(P<0.05).7 days after surgery,the levels of carcinoembryonic antigen,squamous cell carcinoma antigen and cytokeratin 19 serum fragment 21-1 in the observation group were(6.89±1.13)μg/L,(3.15±0.42)μg/L,and(2.89±0.38)μg/L,respectively,which were lower than(8.14±1.25)μg/L,(4.08±0.46)μg/L,(3.87±0.42)μg/L in the control group,and the differencea were statistically significant(P<0.05).Six months after surgery,the scores in the field of physiology,psychology,society and environment in the World Health Organization simple life scale in the observation group were(87.63±6.25)points,(86.59±6.58)points,(88.57±5.58)points and(90.41±4.21)points,respectively,which were higher than(79.31±6.16)points,(78.04±6.32)points,(80.41±6.32)points and(83.47±6.18)points in the control group,and the differences between groups were statistically significant(P<0.05).The recurrence rate of the observation group was 4.88%,lower than 19.51%of the control group,and the perforation rate was 21.95%,higher than 4.88%of the control group,the differences between groups were statistically significant(P<0.05).Conclusion ESD is more effective in the treatment of early esophageal cancer,which can reduce intraoperative blood loss,improve the overall and complete resection rate of the lesion,reduce the level of tumor markers and the risk of long-term recurrence.However,the operation time is longer and there is a higher risk of perforation.
作者
张帅
张昕
ZHANG Shuai;ZHANG Xin(Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan Shandong,250000,China;Department of Imaging,Linyi Hospital of Traditional Chinese Medicine,Linyi Shandong,276002,China)
出处
《反射疗法与康复医学》
2023年第2期105-108,共4页
Reflexology And Rehabilitation Medicine
关键词
食管早癌
内镜下黏膜剥离术
内镜下黏膜切除术
并发症
预后
Early esophageal cancer
Endoscopic submucosal dissection
Endoscopic mucosal resection
Complication
Prognosis
