内镜与外科手术治疗符合内镜黏膜下剥离术扩大适应证的老年单发早期胃癌的疗效对比

doi:10.3969/j.issn.1005-6483.2019.11.012

摘要/Abstract

摘要： 目的：对比内镜与外科手术治疗符合内镜黏膜下剥离术（ESD）扩大适应证的老年单发早期胃癌的临床疗效与安全性。方法：老年单发早期胃癌病人104例，根据治疗方法不同分为两组，内镜组72例，采用经内镜手术治疗，外科组32例，行外科手术治疗。两组病人均满足ESD扩大适应证。对比两组病人的手术时间、住院时间、术后病灶残留、复发、5年存活率及并发症等情况。结果：内镜组的手术时间、术后禁食时间、住院时间和住院费用与外科组比较，差异有统计学意义（P<0.05）；两组的短期并发症总发生率接近（P>0.05），但内镜组的长期并发症总发生率显著低于外科组（P<0.05）；内镜组与外科组的治愈性切除率、整块切除率、病灶残留率、复发率比较，差异均无统计学意义（P>0.05）；两组病人均获得随访，内镜组5年完全生存率、无病生存率分别为100%（72/72）和95.83%（69/72），外科组分别为96.88%（31/32）和93.75%（30/32），组间比较差异无统计学意义（P>0.05）。结论：符合ESD扩大适应证的老年单发早期胃癌病人，实施内镜手术与外科手术治疗的疗效接近，但前者手术耗时短、长期并发症少、术后恢复快。

关键词: 早期胃癌, 内镜黏膜下剥离术, 外科手术, 并发症, 病灶残留

Abstract: Objective：To compare the efficacy and safety of endoscopic and surgical treatment for elderly singleearly early gastric cancer with extended indications of endoscopic submucosal dissection（ESD）.Methods：72 patients with elderly singleearly early gastric cancer treated by endoscopic surgery and 32 patients with early gastric cancer treated by surgery at the same time were respectively enrolled in the endoscopic group and the surgical group.Both groups met the expanded indications of ESD.The operation time，hospitalization time，residual lesions，recurrence，5year survival rate and complications were compared between the two groups.Results：The operation time，fasting time and hospitalization time of the endoscopic group were significantly shorter than those of the surgical group，and the hospitalization expenses were significantly lower than those of the surgical group（P<0.05）；the total incidence of shortterm complications in the two groups was close（P>0.05），but the total incidence of longterm complications in the endoscopic group was significantly lower than that in the surgical group（P<0.05）；the curative resection rate and the total resection rate of the endoscopic group were significantly lower than those in There was no significant difference in residual rate and recurrence rate（P>0.05）.The 5year complete survival rate and diseasefree survival rate were 100% （72/72）and 95.83%（69/72） in endoscopy group,respectively,while in surgery group were 96.88%（31/32） and 93.75%（30/32）,respectively.There was no significant difference between the two groups（P>0.05）.Conclusion：Endoscopic surgery forelderly singleearly early gastric cancer，which meets the expanded indications of ESD，has the advantages of short operation time，less longterm complications and quick recovery.

Key words: early gastric cancer, endoscopic submucosal dissection, surgery, complications, residual lesions

田江, 葛亮, 戴豫新, 黎培员, 田书信. 内镜与外科手术治疗符合内镜黏膜下剥离术扩大适应证的老年单发早期胃癌的疗效对比[J]. 临床外科杂志, 2019, 27(11): 961-964.

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