摘要
目的:对比研究内窥镜黏膜下剥离术(ESD)与外科手术在未分化型早期胃癌(UDEGC)治疗中的远期疗效,以期为初治UDEGC病变的临床决策提供参考。方法:回顾性分析2019年1月至2023年12月就诊于山东第二医科大学附属医院的78例经病理证实为UDEGC患者的临床资料,依据初次治疗方式分为ESD组(21例)及外科手术组(57例),随访两组患者治疗预后情况,并对两组不同年龄段患者分层进行平均生存时长、总生存率、复发率、术后不良事件发生率分析。采用Cox回归模型分析影响生存时长的因素。结果:两组患者平均随访时长、总生存率、手术组平均生存时长、复发率和生存时长比较,差异均无统计学意义(P>0.05)。ESD组手术相关不良事件发生率为23.8%(5/21)少于外科手术组的61.4%(35/57),差异有统计学意义(χ^(2)=8.681,P<0.001)。不同年龄段患者总生存率、复发率比较,差异均无统计学差异(P>0.05)。Cox回归分析显示幽门螺旋杆菌(Hp)感染是影响UDEGC患者生存的危险因素(HR=1.716,95%CI:1.068~2.756,P<0.05)。结论:ESD与外科手术对UDEGC患者具有相同的生存效果,但ESD在减少手术相关不良事件发生率中有显著优势,有助于降低中老年患者治疗相关并发症风险。ESD在术后应密切随访,以及时应对复发事件。
Objective:To compare the long-term efficacy of endoscopic submucosal dissection(ESD)and surgery in the treatment for undifferentiated-type early gastric cancer(UDEGC),so as to provide reference for clinical decision-making in initial treatment for UDEGC lesion.Methods:A total of 78 UDEGC patients who were pathologically confirmed at Affiliated Hospital of Shandong Second Medical University between January 2019 and December 2023 were retrospectively analyzed.Based on the initial treatment,patients were divided into ESD group(n=21)and surgery group(n=57).The prognoses of treatment of two groups were followed up,and a stratified analysis of patients at different age stage of two groups was performed for mean survival time,overall survival rate,recurrence rate,and incidence of postoperative adverse events.A Cox regression model was used to analyze factors affecting survival time.Results:There were not statistically significant differences between the two groups at terms of mean follow-up time,overall survival rate,mean survival time of the surgical group,recurrence rate and survival time(P>0.05).The incidence of surgery-related adverse events in the ESD group was 23.8%(5/21),which was significantly lower than 61.4%(35/57)of the surgery group(χ^(2)=8.681,P<0.001).There were not significant differences at the overall survival rate and recurrence rate among patients with different ages(P>0.05).Cox regression analysis identified Helicobacter pylori infection was a risk factor that affected the survival of UDEGC patients(HR=1.716,95%CI:1.068-2.756,P=0.026).Conclusion:Both ESD and surgery have comparable survival outcomes for UDEGC patients.However,ESD shows a significant advantage in reducing the incidence of surgery-related adverse events,which contributes to reduce the risk of treatment-related complications in middle-aged and elderly patients.Closely postoperative follow-up is recommended to patients who undergo ESD to promptly address potential recurrence.
作者
张黎华
吕晓军
李光彩
代洪生
张小茜
Zhang Lihua;Lyu Xiaojun;Li Guangcai;Dai Hongsheng;Zhang Xiaoqian(The First Department of Gastroenterology,Affiliated Hospital of Shandong Second Medical University,Weifang 261000,China)
出处
《中国医学装备》
2025年第12期69-73,共5页
China Medical Equipment
基金
山东省自然科学基金生物医药联合基金(ZR2022LSW004)。
