摘要
目的探讨老年近、远端早期胃癌及癌前病变内镜黏膜下剥离术(ESD)治疗的疗效与安全性。方法回顾性分析2015年6月至2019年6月期间在中国科学技术大学附属第一医院(安徽省立医院)接受ESD治疗的早期胃癌和癌前病变老年患者148例的临床资料,根据病变部位分成近端组(n=73)和远端组(n=75),观察比较两组患者的性别、年龄、病灶直径、病理类型、浸润深度、手术时间、术中出血量分级、创面直径、术后住院时间等一般情况,同时比较两组患者的病灶整块切除率、治愈性切除率及完全切除率等疗效指标及术中出血、术后出血、穿孔及术后发热率等并发症。结果近端组的男性比例高于远端组(P<0.05),近端组的创面大小、术中出血量大于远端组病灶(P<0.05);近端组的手术时间明显多于于远端组(P<0.05);两组的完全切除率、整块切除率及治愈性切除率无统计学意义(P>0.05);近端组的术后发热率为24.7%,明显高于远端组的9.3%(P<0.05),而两组的术中出血、术后出血、穿孔无统计学意义(P>0.05)。结论ESD术治疗老年患者胃近端病变和远端病变的手术疗效相近,但近端病变相对于远端病变存在更大的手术创伤及更高的术后发热风险。
Objective To investigate the efficacy and safety of endoscopic submucosal dissection(ESD)in elderly patients with proximal and distal early gastric cancer.Methods Clinical data of 155 elderly patients with early gastric cancer and precancerous lesions who received ESD treatment in the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from June 2015 to June 2019 were retrospectively analyzed,and they were divided into proximal group(n=73)and distal group(n=75)according to lesion site.Compare two groups of patients′age,gender,lesion diameter,pathological type,infiltration depth and grade of operation time,intraoperative blood loss,postoperative wound diameter,length of hospital stay,etc.Generally,at the same time to compare two groups of patients with lesions of the whole block resection rate and curative resection rate and complete resection rate and so on curative effect index and intraoperative bleeding and postoperative complications such as bleeding,perforation and postoperative fever rate.Results The proportion of male in the proximal group was higher than that in the distal group(P<0.05).The size of the wound and the amount of intraoperative blood loss in the proximal group were greater than those in the distal group(P<0.05).The operation time of the proximal group was significantly longer than that of the distal group(P<0.05).There was no statistical significance in the total resection rate,block resection rate and curative resection rate between 2 groups(P>0.05).The postoperative fever rate in the proximal group(24.7%)was significantly higher than that in the distal group(9.3%)(P<0.05),while there was no significant difference in intraoperative bleeding,postoperative bleeding and perforation between the two groups(P>0.05).Conclusion ESD in the treatment of elderly patients with proximal and distal gastric lesions has similar surgical efficacy,but proximal lesions have greater surgical trauma and higher risk of postoperative fever compared with distal lesions.
作者
徐翔
张明黎
张开光
王业涛
宋继中
XU Xiang;ZHANG Ming-li;ZHANG Kai-guang;WANG Ye-tao;SONG Ji-zhong(Department of Gastroenterology,Anhui Provincial Hospital,Wannan Medical College,Hefei,230001;Department of Gastroenterology,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),HeFei,230001)
出处
《现代消化及介入诊疗》
2021年第5期576-580,共5页
Modern Interventional Diagnosis and Treatment in Gastroenterology
基金
安徽省科技攻关项目(1604a0802075)。
关键词
早期胃癌
内镜下黏膜剥离术
老年人
安全性
Early gastric cancer
Endoscopic submucosal dissection
aged
security
