早期胃癌患者ESD及外科手术治疗对日常生活能力的影响及相关因素分析

目的统计患者入院及出院时的日常生活活动能力(ADL)评分,分析早期胃癌患者接受内镜下黏膜剥离术(ESD)治疗及外科手术治疗对其生活能力的影响及其相关因素。方法连续纳入自2013年1月至2018年5月因早期胃癌在首都医科大学附属北京友谊医院住院治疗的295例患者,其中接受ESD治疗患者219例(ESD治疗组),接受外科手术治疗患者76例(外科手术组)。对2组患者的临床资料,包括患者入院和出院时的ADL评分、年龄、性别、吸烟史、饮酒史、疾病史、家族史、术后病理类型、病变大小等进行回顾性对比分析,判断早期胃癌患者接受ESD治疗及外科手术治疗对其日常生活活动能力的影响。结果ESD治疗组与外科手术组患者的入院ADL评分比较(98.65±5.28)分vs.(97.83±8.99)分]差异无统计学意义(P>0.05),ESD治疗组的出院ADL评分明显高于外科手术组(98.45±8.25)分vs.(92.70±16.46)分],差异有统计学意义(P<0.001)。多因素线性回归结果提示:年龄与入院ADL评分相关,年龄越大入院ADL评分越低(β=-0.114,P<0.05)。年龄及治疗方式均与出院ADL评分相关,年龄越大出院ADL评分越低(β=-0.220,P<0.001);校正年龄因素后,ESD治疗组的出院ADL评分仍明显高于外科手术组(β=-6.412,P<0.001)。结论治疗方式与年龄为ADL的主要影响因素。接受ESD治疗的早期胃癌患者出院时ADL评分明显高于外科手术治疗患者;另外,对所有入组患者进行日常生活能力评估,提示年龄为ADL评分的独立影响因素,年龄越大,出入院ADL评分越低。

Influence of endoscopic submucosal dissection on activity of daily living in patients with early gastric cancer and precancerous lesions and correlation analysis

Objective To evaluate the influence of endoscopic submucosal dissection(ESD)and surgical treatment on the capability of daily life of patients with early gastric cancer or precancerous lesions using Barthel index in activity of daily living(ADL)scale.Methods A total of 295 patients admitted into Beijing Friendship Hospital,Capital Medical University for early gastric cancer or precancerous lesions and underwent ESD or surgical treatment from Jan 2013 to May 2018 were included consecutively,among whom 219 were treated with ESD(ESD treatment group)and 76 were treated with surgical procedures(surgical group).The analysis intended to evaluate the influence of ESD and surgical treatment on patients'activity of daily living by comparing the clinical features,ADL score(both at admission and discharge),age,gender,history of smoking and alcohol intake,past history and family history,pathology results and size of lesion in both groups.Results There was no statistically significant difference in the admission ADL score of the two groups of patients(98.65±5.28)vs.(97.83±8.99)](P>0.05).The discharge ADL score of the ESD treatment group was significantly higher than that of the surgical group(98.45±8.25)points vs.(92.70±16.46)points],the difference was statistically significant(P<0.001).Linear regression revealed a negative correlation between ADL score at admission and age(β=-0.114,P=0.001).Besides,the ADL score at discharge also decreased as age increased(β=-0.220,P<0.001).After correction for age,patients who were treated with ESD had higher ADL score than those who underwent surgery(β=-6.412,P<0.001).Conclusion For patients with early gastric cancer or precancerous lesions,ESD improves activity of daily living significantly,especially in elderly patients,the ability of daily activity in patients receiving ESD is better than that in patients who undergo surgical treatment.Additionally,the analysis of ADL score of all patients included concluded that older age is an independent risk factor for lower ADL score.