摘要
目的 比较腹腔镜下胃癌根治术(LRG)和内镜黏膜下剥离术(ESD)治疗早期胃癌合并冠心病患者的效果.方法 根据治疗方式的不同将98例早期胃癌合并冠心病患者分为LRG组(n=47,LRG治疗)和ESD组(n=51,ESD治疗),比较两组患者的围手术期指标、疼痛情况[视觉模拟评分法(VAS)]、心功能指标[肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ))、左室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]、应激反应指标[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、肾上腺素(EP)]以及术后心脏并发症发生情况.结果 ESD组患者手术时间、首次排气时间、胃管拔除时间、进食恢复时间、住院时间均短于LRG组,术中出血量少于LRG组,术后心脏并发症总发生率低于LRG组,差异均有统计学意义(P﹤0.05).术后6h、1天、3天、7天,两组患者VAS评分均低于本组术前,ESD组患者VAS评分均低于LGR组,差异均有统计学意义(P﹤0.05).术后12 h,两组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均高于本组术前,LRG组患者LVEF、CI、CO均低于本组术前,ESD组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均低于LRG组,LVEF、CI、CO均高于LRG组,差异均有统计学意义(P﹤0.05).结论 与LRG比较,ESD治疗早期胃癌合并冠心病患者的安全性高、手术时间短、术中出血量少、手术创伤小、术后疼痛程度轻,因此患者术后应激反应更轻,对患者心功能的不良影响更小,术后恢复更快.
Abstract
Objective To compare the efficacy of laparoscopic radical gastrectomy(LRG)and endoscopic submuco-sal dissection(ESD)in the treatment of patients with early gastric cancer complicated with coronary heart disease.Method A total of 98 patients with early gastric cancer complicated with coronary heart disease were divided into LRG group(n=47,LRG treatment)and ESD group(n=51,ESD treatment)according to different treatment methods,and the perioperative period indexes,pain conditions[visual analogue scale(VAS)],cardiac function indexes[creatine kinase iso-enzyme-MB(CK-MB),cardiac troponinⅠ(cTnⅠ),left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac out-put(CO)],stress response indexes[high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),inter-leukin-6(IL-6),cortisol(Cor),adrenocorticotropic hormone(ACTH),epinephrine(EP)]and incidence of postoperative cardiac complications of the two groups were compared.Result The surgery time,first exhaust time,gastric tube remov-al time,feeding recovery time and hospital stay in ESD group were shorter than those in LRG group,the intraoperative blood loss was less than that in LRG group,and the total incidence of postoperative cardiac complications was lower than that in LRG group,and the differences were statistically significant(P<0.05).At 6 h,1 day,3 days and 7 days after sur-gery,the VAS scores in two groups were lower than those before surgery,the VAS scores in ESD group were lower than those in LGR group,and the differences were statistically significant(P<0.05).At 12 h after surgery,the CK-MB,cTnⅠ,hs-CRP,TNF-α,IL-6,Cor,ACTH and EP in two groups were higher than those before surgery,the LVEF,CI and CO in LRG group were lower than those before surgery,the CK-MB,cTnⅠ,hs-CRP,TNF-α,IL-6,Cor,ACTH and EP in ESD group were lower than those in LRG group,the LVEF,CI and CO were higher than those in LRG group,and the differenc-es were statistically significant(P<0.05).Conclusion Compared with LRG,ESD in the treatment of patients with early gastric cancer complicated with coronary heart disease has higher safety,shorter surgery time,less intraoperative blood loss,less surgical trauma and less postoperative pain.Therefore,the postoperative stress reaction of patients is lighter,the adverse impact on the cardiac function of patients is less,and the postoperative recovery is faster.
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