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早期胃癌行内镜黏膜下剥离术的疗效及术中出血危险因素分析

Efficacy of endoscopic submucosal dissection for early gastric cancer and analysis in risk factors of intraoperative bleeding

    摘要
  • 摘要:
    目的 分析内镜黏膜剥离术(ESD)对早期胃癌患者的疗效及术中出血危险因素。
    方法 将156例早期胃癌患者随机分为ESD组(n=78)和全腹腔镜下远端胃切除术(TLDG)组(n=78)。比较2组患者术后疗效和血清肿瘤标志物水平; 对影响早期胃癌患者术中出血的因素行单因素分析、多因素Logistic回归分析。
    结果 ESD组病灶完全切除率、病灶整块切除率高于TLDG组，肠胃功能恢复时间、住院时间、术后开始进食时间、住院费用、术后恢复时间均短于或低于TLDG组，差异有统计学意义(P<0.05)。ESD组患者术后糖类抗原199(CA199)、糖类抗原125(CA125)水平低于TLDG组，胃蛋白酶原Ⅰ(PG Ⅰ)水平高于TLDG组，差异有统计学意义(P<0.05)。根据术中出血情况将患者分为出血组(n=33)和未出血组(n=123), 出血组年龄≥60岁、体质量指数(BMI)≥27 kg/m2、伴有溃疡、手术时间>150 min的患者比率高于未出血组, 差异有统计学意义(P<0.05)。多因素Logistic回归分析发现，年龄≥60岁、BMI≥27 kg/m2、手术时间>150 min、合并溃疡是影响胃癌患者术中出血的独立危险因素(P<0.05)。
    结论 ESD治疗早期胃癌患者疗效较好，可有效控制血清标志物水平，减少术中出血量。年龄≥60岁、BMI≥27 kg/m2、手术时间>150 min、合并溃疡是影响胃癌患者术中出血的独立危险因素。

     

    Abstract:
    Objective To analyze the efficacy of endoscopic submucosal dissection (ESD) for patients with early gastric cancer and the risk factors of intraoperative bleeding.
    Methods A total of 156 patients diagnosed as early gastric cancer were randomly divided into ESD group (n=78) and total laparoscopic distal gastrectomy (TLDG) group (n=78). The postoperative efficacy and levels of serum tumor markerswere compared between the two groups; the univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of intraoperative bleeding in patients with early gastric cancer.
    Results The complete resection rate and en bloc resection rate of the lesion in the ESD group were significantly higher than those in the TLDG group, while the gastrointestinal function recovery time, hospital stay, postoperative fasting time, hospitalization costs and postoperative recovery time were significantly shorter or lower than those in the TLDG group (P<0.05). After operation, levels of carbohydrate antigen 199 (CA199) and carbohydrate antigen125 (CA125) in the ESD group were significantly lower than those in the TLDG group, while the level of pepsinogen Ⅰ (PG Ⅰ) was significantly higher than that in the TLDG group (P<0.05). According to the bleeding situation, the patients were divided into bleeding group (n=33) and non-bleeding group (n=123), and the ratios of patients with age≥60 years old, body mass index (BMI) ≥27 kg/m2, accompanied by ulcer, and operation time>150 minutes in the bleeding group were significantly higher than those in the non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that age≥60 years old, BMI≥27 kg/m2, operation time>150 minutes and accompanied by ulcer were the independent risk factors for intraoperative bleeding in patients with gastric cancer (P<0.05).
    Conclusion ESD shows a good therapeutic effect in patients with early gastric cancer, which can effectively control levels of serum markers and reduce volume of intraoperative bleeding. Age≥ 60 years old, BMI≥27 kg/m2, operation time>150 minutes and accompanied by ulcer are the independent risk factors for intraoperative bleeding in patients with gastric cancer.

     

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