内镜下黏膜切除术及黏膜剥离术治疗早期胃癌和癌前病变的疗效对比研究

目的对比分析内镜下黏膜切除术（EMR）和内镜下黏膜剥离术（ESD）对治疗早期胃癌（EGC）和癌前病变的效果和安全性。 方法选取2015年1月至2016年1月无锡市第二人民医院收治的60例EGC和癌前病变患者为研究对象，根据治疗方式分为EMR组（32例）和ESD组（28例），对比分析两组患者的手术时间、禁饮禁食时间、术中出血情况、术后病理、整块切除率、治愈性切除率、肿瘤局部复发率、肿瘤残留率和术中、术后不良反应及预后情况。 结果ESD组患者手术时间长于EMR组［（53.35±7.12）min vs（34.23±5.74）min，t=2.009，P=0.043］，术中出血量多于EMR组［（10.26±3.42）ml vs（3.35±0.71）ml，t=2.511，P=0.018］，差异有统计学意义。ESD组患者病灶整块切除率（92.9% vs 62.5%，χ²=7.693，P=0.006）及治愈性切除率（78.6% vs 43.8%，χ²=7.545，P=0.006）均高于EMR组患者，差异有统计学意义。ESD组不良反应率为14.3%（4/28），高于EMR组的3.1%（1/32），差异有统计学意义（χ²=8.765，P=0.001）。两组患者术后2年总生存率比较，差异无统计学意义（χ²=0.643，P=0.423）。 结论与EMR相比，ESD可能是治疗EGC及癌前病变的一种较为安全有效的手术方式。

Comparison of the efficacy of endoscopic mucosal resection and endoscopic submucosal dissection in thetreatment of early gastric cancer and precancerous lesions

ObjectiveTo compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of early gastric cancer (EGC) and precancerous lesions. MethodsFrom January 2015 to January 2016, sixty patients with EGC and precancerous lesions admitted to Wuxi Second People’s Hospital were divided into EMR group (32 cases) and ESD group (28 cases). The operative time and dietary restriction, intraoperative hemorrhage, postoperative pathology, the rate of total excision, curative resection, local recurrence, tumor residual, intraoperative and postoperative adverse reactions and the prognosis between the two groups were compared and analyzed. ResultsThe operation time of ESD group was longer than that of EMR group (53.35±7.12) min vs (34.23±5.74) min,t=2.009, P=0.043], the intraoperative blood loss was more than that of EMR group, with statistically significant differences (10.26±3.42) ml vs (3.35±0.71) ml, t=2.511, P=0.018]. The total excision rate and curative resection rate of lesions in ESD group were significantly higher than those in EMR group (92.9% vs 62.5%, χ2=7.693, P=0.006; 78.6% vs 43.8%, χ2=7.545, P=0.006). The adverse reaction rate of ESD group was 14.3% (4/28), higher than that of EMR group 3.1% (1/32), and the difference was statistically significant (χ2=8.765, P=0.001). There was no significant difference in the 2-year overall survival rate between the two groups (χ2=0.643, P=0.423). ConclusionCompared with EMR, ESD may be a safe and effective surgical procedure for the treatment of EGC and precancerous lesions.