内镜黏膜下剥离术治疗胃肠神经内分泌肿瘤的效果及其对血清IL-6、TNF-α、CgA水平的影响

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目的:探讨内镜黏膜下剥离术(ESD)治疗胃肠神经内分泌肿瘤(GI-NENs)的临床效果及其对患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、嗜铬粒蛋白A (CgA)水平的影响。方法:抽取平煤神马医疗集团总医院2015年5月至2018年5月收治的拟行内镜手术治疗的GI-NENs患者60例,其中行内镜下黏膜切除(EMR)术的30例患者作为对照组,行ESD术的另30例患者作为观察组。记录并对比两组患者的围术期相关指标,肿瘤完全切除率,垂直切缘阴性率,术前与术后3 d的血清IL-6、TNF-α、CgA水平,术后并发症,以及术后1年的复发率和异时癌发生率。结果:观察组手术时间长于对照组[(30.22±6.12)min比(15.85±3.85)min],住院时间短于对照组[(4.25±1.12)d比(5.52±1.55)d],治疗费用多于对照组[(5 064.25±992.54)元比(2 815.56±559.26)元],差异有统计学意义(n P<0.05)。观察组肿瘤完全切除率(96.67%,29/30)高于对照组(76.67%,23/30),n P<0.05。术后3 d,两组患者的血清IL-6、TNF-α及CgA水平低于术前(n P<0.05),且观察组血清CgA水平[(45.25±8.25)mg/ml]低于对照组[(71.26±12.82)mg/ml],n P<0.05。观察组的术后并发症总发生率(10.00%,3/30)低于对照组(33.33%,10/30),n P<0.05。观察组术后1年复发率(3.33%,1/30)低于对照组(23.33%,7/30),n P<0.05。n 结论:选择ESD术治疗GI-NENs能缩短住院时间,提高肿瘤完全切除率,有效下调血清CGA水平,减少术后并发症,以上优于EMR术,且远期复发率低于EMR术,但患者手术时间和住院费用相比EMR并不具有优势。“,”Objective:To investigate the effects of endoscopic submucosal dissection (ESD) on gastrointestinal neuroendocrine neoplasms (GI-NENs) and its influence on serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and chromogranin A (CgA).Methods:A total of 60 GI-NENs patients who were treated in Pingmei Shenma Medical Group General Hospital from May 2015 to May 2018 were selected. Among them, 30 patients who underwent endoscopic mucosal resection (EMR) were selected as control group, and the other 30 patients who underwent ESD were selected as observation group. The perioperative related indicators, complete tumor resection rate, negative rate of vertical resection margin, levels of serum IL-6, TNF-α and CgA before surgery and 3 d after surgery, postoperative complications, recurrence rate and incidence of metachronous cancer 1 year after surgery were recorded and compared between the two groups.Results:The surgical time of observation group was (30.22±6.12)min, significantly longer than the (15.85±3.85)min of control group (n P<0.05). The hospital stay of observation group was (4.25±1.12)d, significantly shorter than the (5.52±1.55)d of control group (n P<0.05). The cost of treatment of observation group was significantly more than that of control group, (5 064.25±992.54) yuann vs. (2 815.56±559.26) yuan, n P<0.05. The complete tumor resection rate of observation group (96.67%, 29/30) was significantly higher than that of control group (76.67%, 23/30),n P<0.05. In the two groups, the levels of serum IL-6, TNF-α and CgA 3 d after surgery were significanty lower than those before surgery (n P<0.05). The serum CgA of observation group was (45.25±8.25)mg/ml, significantly lower than the (71.26±12.82)mg/ml of control group (n P<0.05). The total incidence of postoperative complications in observation group (10.00%, 3/30) was significantly lower than that in control group (33.33%, 10/30),n P<0.05. The recurrence rate at 1 year after surgery in observation group (3.33%, 1/30) was significantly lower than that in control group (23.33%, 7/30),n P<0.05.n Conclusions:ESD for GI-NENs can more effectively shorten the hospital stay, increase the complete tumor resection rate, effectively regulate the serum CGA level, reduce postoperative complications, and decrease long-term recurrence rate, in these aspects ESD was superior to EMR surgery. However, ESD has no advantage of surgical time or hospitalization over EMR.
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