实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (9): 927-930.doi: 10.3969/j.issn.1003-9198.2021.09.009

• 临床研究 • 上一篇    下一篇

内镜黏膜下剥离术与外科手术治疗老年单发早期胃癌病人的临床效果比较

张瑾, 张国新   

  1. 210029 江苏省南京市,南京医科大学第一附属医院消化科
  • 收稿日期:2021-01-09 发布日期:2021-09-13
  • 通讯作者: 张国新,Email:guoxinz@njmu.edu.cn
  • 基金资助:
    江苏省六大人才高峰(2018-WSW-040)

Comparison of clinical effects between endoscopic submucosal dissection and surgical treatment in elderly patients with single early gastric cancer

ZHANG Jin, ZHANG Guo-xin   

  1. Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
  • Received:2021-01-09 Published:2021-09-13

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摘要： 目的 探讨符合内镜黏膜下剥离术(ESD)绝对适应证或扩大适应证的老年单发早期胃癌病人接受ESD与接受外科手术切除治疗的疗效、并发症、生存率等方面的差异。 方法 收集2013～2018年在南京医科大学第一附属医院行ESD(ESD组,148例)或外科手术切除(外科手术组,339例)的老年单发早期胃癌病人的临床资料。统计分析2组术后禁食时间、手术操作时间、住院时间、住院费用等手术情况;比较2组整块切除、局部复发、同时性复发、异时性复发、术后并发症的发生率;采用Kaplan-Meier法分析2组总生存率。 结果 2组整块切除率、局部复发率、同时性复发率、异时性复发率差异均无统计学意义(P＞0.05)。ESD组的术后禁食时间、手术操作时间、住院时间、住院费用均少于外科手术组(均P＜0.01)。ESD组并发症总发生率显著低于外科手术组(3.38%比15.04%,P＜0.01)。2组5年完全生存率差异无统计学意义(95.9％比96.5％,P＝0.531)。 结论 对于符合ESD绝对适应证或扩大适应证的老年单发早期胃癌病人,与外科手术相比,ESD的疗效无显著差异,但其手术操作时间及住院时间短,住院费用少,并发症发生率低,可以作为首选治疗方式。

关键词: 老年人, 早期胃癌, 外科手术, 内镜黏膜下剥离术, 临床疗效

Abstract: Objective To investigate the differences between endoscopic submucosal dissection (ESD) and surgical treatment in efficacy, complications, survival benefit in the elderly patients with single early gastric cancer who meet the absolute indications or expanded indications of ESD. Methods From January 2013 to December 2018, the clinical data of the elderly patients with single early gastric cancer who underwent ESD (ESD group, 148 cases) or surgical treatment (surgery group, 339 cases) in the First Affiliated Hospital with Nanjing Medical University were included in this retrospective study. The postoperative fasting time, operation time, hospitalization time, hospitalization expenses of the two groups were recorded and analyzed. The rates of en bloc resection, local recurrence, simultaneous recurrence, metachronous recurrence, and postoperative complications were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival rate of the two groups. Results There were no significant differences in the rates of en bloc resection, local recurrence, simultaneous recurrence and metachronous recurrence. ESD group showed less postoperative fasting time (P＜0.01), operation time (P＜0.01), hospitalization time (P＜0.01), and hospitalization expenses (P＜0.01) than surgical group. The total incidence rate of the complications in ESD group was significantly lower than that in surgical group (3.38% vs 15.04%, P＜0.01). There was no significant difference in the 5-year complete survival rate between the two groups (95.9% vs 96.5%, P=0.531). Conclusions For the elderly patients with single early gastric cancer who meet the absolute indications or the expanded indications, there is no significant difference in efficacy between ESD and surgery treatment, while ESD group shows less postoperative fasting time, operation time, hospitalization time, hospitalization expenses, and lower incidence of complications, so ESD can be used as the preferred treatment.

Key words: aged, early gastric cancer, surgical treatment, endoscopicsubmucosal dissection, clinical effect

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