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目的探讨内镜黏膜下剥离术治疗早期胃癌的临床效果。方法选取2013年1月至2016年7月间四川省彭州市人民医院收治的116例早期胃癌患者,采用随机数表法分为观察组和对照组,每组58例。观察组患者采用内镜黏膜下剥离术,对照组患者采用常规外科手术,观察两组患者癌肿一次性整块切除率、组织学治愈性切除率、术后溃疡愈合率、局部残留率及复发率,对所有患者行治疗后1年、2年和3年随访,比较两组患者生存率。结果观察组患者术中出血发生率和迟发性出血发生率为19.0%和0.0%,均低于对照组患者的39.7%和6.9%,差异均有统计学意义(均P<0.05)。观察组患者平均手术时间为(95.65±27.07)min,平均住院天数为(8.37±1.71)d,均短于对照组患者的(165.04±17.12)min和(12.75±1.81)d,差异均有统计学意义(均P<0.05)。观察组患者总并发症发生率为3.5%,低于对照组患者的22.4%,差异有统计学意义(P<0.05)。观察组患者治疗后2年和3年生存率分别为98.3%和87.9%,高于对照组患者的87.9%和74.1%,差异均有统计学意义(均P<0.05)。两组患者治疗后1年的生存率比较,差异无统计学意义(P>0.05)。结论内镜黏膜下剥离术是治疗早期胃癌安全有效的方法,手术效果、手术时间及术后并发症的发生率均优于常规外科手术,值得临床推荐。
Objective To investigate the clinical effect of endoscopic submucosal dissection in the treatment of early gastric cancer. Methods One hundred and sixty-one patients with early-stage gastric cancer who were admitted to Pengzhou People’s Hospital of Sichuan Province between January 2013 and July 2016 were randomly divided into observation group and control group with 58 cases in each group. Patients in the observation group were treated with endoscopic submucosal dissection, and patients in the control group were treated by conventional surgery. One-time resectability of the cancer, histological curative resection rate, postoperative ulcer healing rate, local residual rate and recurrence were observed All patients were followed up for 1 year, 2 years and 3 years after treatment. The survival rates of the two groups were compared. Results The incidence of intraoperative hemorrhage and delayed hemorrhage in the observation group was 19.0% and 0.0%, respectively, which were lower than those in the control group (39.7% and 6.9%, both P <0.05). The average operation time in the observation group was (95.65 ± 27.07) min and the average length of stay was (8.37 ± 1.71) days, both of which were shorter than those in the control group (165.04 ± 17.12) min and (12.75 ± 1.81) d, respectively Significance (both P <0.05). The incidence of total complication in the observation group was 3.5%, which was lower than that in the control group (22.4%), the difference was statistically significant (P <0.05). The 2-year and 3-year survival rates of patients in the observation group were 98.3% and 87.9% after treatment, respectively, which were significantly higher than those in the control group (87.9% and 74.1%, both P <0.05). There was no significant difference in survival rate between two groups after one year of treatment (P> 0.05). Conclusion Endoscopic submucosal dissection is a safe and effective method for the treatment of early gastric cancer. The effect of surgery, the operation time and the incidence of postoperative complications are superior to conventional surgical procedures, which is worthy of clinical recommendation.