无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响

doi:10.20223/j.cnki.1000-8535.2024.11.012

摘要/Abstract

摘要： 目的探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

关键词: 消化内镜, 无痛, 高频电刀, 胃癌前病变, 内镜黏膜下剥离术, 复发率

Abstract: Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

Key words: digestive endoscopy, painless, high frequency electric knife, gastric precancerous lesions, endoscopic submucosal dissection, recurrence rate

郭永锋, 李利娟, 孙苗苗, 马宁, 吴贵荣. 无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响[J]. 广州医药, 2024, 55(11): 1314-1318.

GUO Yongfeng, LI Lijuan, SUN Miaomiao, MA Ning, WU Guirong. The application effect and recurrence rate of high-frequency electric knife therapy under painless digestive endoscopy on gastric precancerous lesions[J]. Guangzhou Medical Journal, 2024, 55(11): 1314-1318.

参考文献

[1] CHEN P C,LU Y R,KANG Y N,et al.The accuracy of artificial intelligence in the endoscopic diagnosis of early gastric cancer:Pooled analysis study[J].J Med Internet Res.2022,24(5):e27694.
[2] LIU Q,DING L,QIU X,et al.Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer:A systematic review and meta-analysis[J].Int J Surg.2020(73):28-41.
[3] 柴小兵,段旭红,李娅,等.内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效[J].中国内镜杂志,2018,24(1):50-55.
[4] 刘菊梅,梁丽,张继新,等.411例早期胃癌及癌前病变内镜黏膜下剥离术标本的病理学评估[J].北京大学学报(医学版),2023,55(2):299-307.
[5] 白钰. 无痛消化内镜下高频电刀治疗胃肠息肉的可行性研究[J].中国现代药物应用,2023,17(5):44-46.
[6] 商棕转. 无痛消化内镜下高频电刀手术治疗老年胃肠息肉患者的效果[J].中国民康医学,2023,35(3):41-44.
[7] 徐翔,张明黎,张开光,等.ESD治疗老年近、远端早期胃癌及癌前病变的疗效与安全性[J].现代消化及介入诊疗,2021,26(5):576-580.
[8] ZHAN Y,LIANG S,YANG Z,et al.Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy:A prospective,double-blind,randomized controlled trial[J].BMC Gastroenterol,2022,22(1):391.
[9] 蔡仁颂,杨维忠,崔光锐,等.内镜黏膜下剥离术治疗老年早期贲门癌的疗效分析及对患者预后的影响[J].临床和实验医学杂志,2022,21(14):1505-1509.
[10] 粱寒. 第7版UICC-AJCC胃癌TNM分期及日本胃癌新分期、胃癌治疗指南的临床应用前景[C]// 第七届全国胃癌学术会议论文集. 2012:92-96.
[11] 中华中医药学会脾胃病分会,中华医学会消化病学分会消化肿瘤协作组,中华医学会消化内镜学分会早癌协作组,等.中国整合胃癌前病变临床管理指南[J].中国中西医结合消化杂志,2022,30(3):163-183.
[12] 徐星榕,白菊萍,边芸,等.CK、MUC5ac、Ki67表达与胃癌癌前病变的关系及对胃癌早期诊断的价值[J].国际检验医学杂志,2023,44(12):1522-1525.
[13] 丁蕾蕾,贾程普,焦月,等.内镜黏膜下剥离术应用1940 nm铥激光与高频电刀治疗食管早癌或癌前病变的临床疗效分析[J].临床和实验医学杂志,2021,20(13):1377-1381.
[14] 郑倩,谭斌,曹慧秋,等.胃癌前病变患者病变组织c-Myc蛋白表达情况及其与内镜黏膜下剥离术后复发的关系[J].广西医学,2023,45(13):1525-1528.
[15] 崔海坡,黄嘉平,宋成利,等.不同尺寸参数对双极高频电刀热应力场的影响[J].医用生物力学,2019,34(2):179-185.
[16] 宋亚华,安苗,秦赟,等.胃肠息肉患者实施无痛消化内镜下高频电刀治疗对并发症及术后恢复的影响[J].现代消化及介入诊疗,2022,27(5):603-605.
[17] 陈梅,张昱,李冬梅,等.MAML1与胃癌进展和预后相关性的生物信息学分析[J].广州医药,2023,54(1):56-63.
[18] 王霄腾,韩丰,王超,等.OLGA胃炎评价标准在胃黏膜癌前状态和癌前病变风险评估中的价值[J].中华医学杂志,2022,102(12):853-857.
[19] 王慕蕴,李智,卢先枝,等.内镜下黏膜剥离术与常规外科肿瘤切除术对早期胃癌患者术中肿瘤切除率、术后复发率的影响[J].实用癌症杂志,2022,37(10):1653-1656.
[20] 王莉莉,郭慧敏,张昆鹏.内镜黏膜切除术和内镜黏膜下剥离术对早期胃癌及癌前病变患者胃蛋白酶原和生活质量的影响[J].癌症进展,2023,21(13):1424-1427.
[21] 侯运萌,李海.无痛消化内镜与普通消化内镜下高频电刀切除术治疗胃肠息肉效果观察[J].中国医疗器械信息,2023,29(16):69-71.
[22] 张维,袁帅.内镜黏膜下剥离术治疗结直肠高级别上皮内瘤变的临床研究[J].广州医药,2021,52(5):88-91.
[23] 刘君. 无痛消化内镜下高频电刀治疗胃肠息肉的效果观察研究[J].现代消化及介入诊疗,2019(A01):0684-0685.
[24] 秦林,丁卫民,张建英,等.冷冻联合球囊扩张术治疗瘢痕狭窄型支气管结核气道闭塞的有效性及安全性[J].中华结核和呼吸杂志,2018,41(11):857-862.
[25] 邵晓朵,余少敏,陈如君.无痛消化内镜下高频电刀治疗胃肠息肉临床效果及并发症分析[J].生命科学仪器,2022,20(z1):3.