内镜下黏膜剥离术联合术后羟乙基淀粉对上消化道早癌患者术后应激指标的影响

Effect of endoscopic submucosal dissection combined with postoperative hydroxyethyl starch on postoperative stress indicators in patients with early upper gastrointestinal cancer

摘要:

目的 探讨内镜下黏膜剥离术（ESD）联合术后羟乙基淀粉对上消化道早癌患者术后应激指标的影响。方法 选取2021年1月—2025年1月在邯郸市第一医院接受手术治疗的108例上消化道早癌患者作为研究对象，根据治疗方法的不同分为观察组和对照组，分别有55、53例。对照组接受ESD治疗，观察组接受ESD和术后羟乙基淀粉治疗。比较两组术后胃肠功能恢复情况，以及术前和术后1周的炎症因子水平、氧化应激指标、营养指标。对患者术后进行为期3个月的随访，记录并发症情况和复发率。结果 观察组首次排气时间、首次排便时间、腹痛缓解时间、进食恢复时间均短于对照组（P <0.05）。观察组术后白细胞介素-8（IL-8）、IL-6、肿瘤坏死因子-α（TNF-α）水平均低于对照组（P <0.05）。观察组治疗前后IL-8、IL-6、TNF-α差值均小于对照组（P <0.05）。观察组术后丙二醛（MDA）、皮质醇（Cor）、C反应蛋白（CRP）、去甲肾上腺素（NE）水平均低于对照组（P <0.05）。观察组治疗前后MDA、Cor、CRP、NE差值均小于对照组（P <0.05）。观察组术后白蛋白（ALB）、血红蛋白（Hb）、血清总蛋白（TP）水平均高于对照组（P <0.05）。观察组治疗前后ALB、Hb、TP差值均小于对照组（P <0.05）。观察组局部复发率低于对照组（P <0.05）。结论 ESD联合术后羟乙基淀粉有助于降低上消化道早癌患者术后应激反应，改善术后营养和胃肠功能。

Abstract:

Objective To investigate the effect of endoscopic submucosal dissection (ESD) combined with postoperative hydroxyethyl starch on postoperative stress indicators in patients with early upper gastrointestinal cancer.Methods A total of 108 patients with early upper gastrointestinal cancer who underwent surgical treatment at Handan First Hospital from January 2021 to January 2025 were enrolled, and divided into an observation group and a control group according to different treatment regimens. There were 53 patients in the control group who received ESD, and 55 patients in the observation group who received ESD combined with postoperative hydroxyethyl starch therapy. The postoperative recovery of gastrointestinal function, as well as the levels of inflammatory factors, oxidative stress indicators and nutritional indicators before surgery and at 1 week after surgery were compared between the two groups. All patients were followed up for 3 months after surgery to record the incidence of complications and the local recurrence rate.Results The first time to flatus, first time to defecation, time to abdominal pain relief, and time to resumption of oral intake were all shorter in the observation group than in the control group (P < 0.05). Postoperative levels of IL-8, IL-6, and TNF-α were lower in the observation group than in the control group (P < 0.05). The changes in IL-8, IL-6, and TNF-α levels before and after treatment were smaller in the observation group than in the control group (P < 0.05). Postoperative levels of MDA, Cor, CRP, and NE were lower in the observation group than in the control group (P < 0.05). The changes in these indicators before and after treatment were also smaller in the observation group than in the control group (P < 0.05). Postoperative levels of ALB, Hb, and TP were higher in the observation group than in the control group (P < 0.05), while the changes in these indicators before and after treatment were smaller in the observation group (P < 0.05). The local recurrence rate was lower in the observation group than in the control group (P < 0.05).Conclusion ESD combined with postoperative hydroxyethyl starch is helpful to reduce postoperative stress and improve postoperative nutrition and gastrointestinal function in patients with early upper gastrointestinal cancer.