内镜黏膜下剥离术和外科手术治疗早期胃癌的疗效评价

Evaluation of the therapeutic effect of endoscopic submucosal dissection and surgical treatment for early gastric cancer

摘要:

目的 比较内镜黏膜下剥离术（ESD）和外科手术对早期胃癌的治疗效果。方法 收集2021年10月—2024年11月在马鞍山市人民医院消化内科及胃肠外科进行ESD术和外科手术治疗的早期胃癌且术后病理检查确定为T₁N₀M₀期患者的临床资料。共纳入97例患者，按照手术方式的不同分为ESD组57例和手术组为40例。比较两组患者的性别、年龄、手术方式、住院时长、住院费用、并发症、相关病理结果和随访情况等，综合评估ESD和外科手术治疗早期胃癌的疗效和安全性。结果 ESD组与手术组患者的性别构成、年龄、胃癌部位、肿瘤大小比较，差异均无统计学意义（P >0.05）。ESD组以高级别上皮内瘤变为主，占63.16%（36/57），腺癌占比36.84%（21/57），并未出现印戒细胞癌；手术组腺癌占比65.00%（26/40），高于ESD组（P <0.05），高级别上皮内瘤变占比15.00%（6/40），同时出现20.00%（8/40）的印戒细胞癌。两组浸润深度比较，差异有统计学意义（P <0.05）；ESD组多为黏膜层及黏膜下层病变，而手术组多为突破黏膜的病变。手术组住院时间和住院费用均高于ESD组（P >0.05）。结论 相较于外科手术，ESD治疗早期胃癌安全有效，且创伤小、住院时间短、住院费用低。

Abstract:

Objective To compare the therapeutic effects of endoscopic submucosal dissection (ESD) and surgical treatment for early gastric cancer.Methods The clinical data of patients with early gastric cancer who underwent ESD or surgical treatment in the Department of Gastroenterology and Department of Gastrointestinal Surgery of Ma'anshan People's Hospital from October 2021 to November 2024 and confirmed as T₁N₀M₀ stage by postoperative pathological examination were collected. A total of 97 patients were included and divided into the ESD group (57 cases) and the surgical group (40 cases) according to different surgical methods. The gender, age, gastric cancer location, tumor size, length of hospital stay, hospitalization expenses, complications, relevant pathological results and follow-up status of the two groups were compared to comprehensively evaluate the efficacy and safety of ESD and surgical treatment for early gastric cancer.Results There were no statistically significant differences in gender composition, age, gastric cancer location and tumor size between the ESD group and the surgical group (P > 0.05). The ESD group was mainly high-grade intraepithelial neoplasia, accounting for 63.16% (36/57), adenocarcinoma accounted for 36.84% (21/57), and no signet ring cell carcinoma was found. The proportion of adenocarcinoma in the surgical group was 65.00% (26/40), which was higher than that in the ESD group (P < 0.05); the proportion of high-grade intraepithelial neoplasia was 15.00% (6/40), and 20.00% (8/40) of signet ring cell carcinoma was found. There was a statistically significant difference in invasion depth between the two groups (P < 0.05): most lesions in the ESD group were in the mucosal and submucosal layers, while most lesions in the surgical group were those breaking through the mucosa. The length of hospital stay and hospitalization expenses in the surgical group were higher than those in the ESD group (P > 0.05).Conclusion Compared with surgical treatment, ESD is safe and effective in the treatment of early gastric cancer, with the advantages of less trauma, shorter hospital stay and lower hospitalization expenses.