二氧化碳环境下内镜黏膜下剥离术治疗早期胃癌临床观察

目的：探讨二氧化碳( CO2)环境下内镜黏膜下剥离术( ESD)对早期胃癌( EGC)患者预后的影响。方法选择2012年1月—2014年1月我院择期行ESD的EGC患者96例,随机分为CO2组和空气组,每组48例,观察两组组织学疗效、手术及术后恢复情况、血气指标变化及术后并发症,平均随访16个月,记录两组复发情况。结果两组组织学疗效、手术时间、术后出血、纵隔气肿、皮下气肿发生率、术后血二氧化碳分压和血氧饱和度水平比较差异无统计学意义(P>0．05)；CO2组膈下游离气体深度小于空气组,进食时间、住院时间和气腹完全消失时间均较空气组短,术后穿孔发生率低于空气组(P<0．05,P<0．01)。 CO2组术后无一例复发。结论 ESD术中应用CO2对血气指标无影响,且能够缩短术后恢复时间,降低穿孔发生率。

Clinical Observation of Endoscopic Submucosal Dissection in Treatment of Patients with Early Gastric Cancer under CO2 Environment

Objective To investigate effect of endoscopic submucosal dissection ( ESD) on prognosis of patients with early gastric cancer ( EGC) under carbon dioxide ( CO2 ) environment. Methods A total of 96 patients with EGC undergoing ESD between January 2012 and January 2014 were randomly divided into CO2 group (n=48) and air group (n=48). In two groups, histological effect, intraoperative and postoperative conditions, changes of blood gas indexes before and after operation were observed, and recurrence rates were recorded with average 16 months of follow-up. Re-sults There were no significant differences in histological effect, operative time, incidence rates of postoperative bleed-ing, mediastinal emphysema and subcutaneous emphysema, postoperative PaCO2 and arterial oxygen saturation ( SpO2 ) levels in two groups (P>0. 05). Values of depth of subphrenic free air, dieting time, hospitalization time and pneumo-peritoneum completely disappearing time were lower, and postoperative incidence rate of perforation was lower in CO2 group than those in air group (P<0. 05, P<0. 01). No recurrence was found in CO2 group. Conclusion CO2 in appli-cation of ESD proves to be of no effect on blood gas indexes, and it can reduce postoperative recovery time as well as inci-dence rate of perforation.