超声内镜辅助内镜黏膜下切除术对食管癌前病变患者术后应激反应及血清鳞状上皮细胞癌抗原水平的影响
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摘要
目的探讨超声内镜辅助内镜黏膜下切除术(EMR)对食管癌前病变患者术后应激反应及血清鳞状上皮细胞癌抗原(SCC)水平的影响。方法前瞻性选取2015年11月至2017年6月收治的食管癌前病变患者76例,随机数字表法分为对照组(n=38)与研究组(n=38)。研究组采取超声内镜辅助EMR,对照组采取EMR。术后统计两组手术用时及流质饮食时间,术前及术后即刻血清应激反应指标(去甲肾上腺素、肾上腺素、醛固酮、血管紧张素Ⅱ及肾素)水平,血清肿瘤标志物[细胞角蛋白19血清片段21-1(CYFRA21-1)、肿瘤特异性生长因子(TSGF)]水平,SCC水平和术后第7天及1个月血清遗传学分子[细胞周期素E(Cyclin E)、转化生长因子-α(TGF-α)]水平。结果研究组手术用时及流质饮食时间较对照组少(P<0.05);术后两组血清去甲肾上腺素、肾上腺素、醛固酮、血管紧张素Ⅱ及肾素水平较术前增高,但研究组较对照组低(P<0.05);术后两组血清CYFRA21-1、TSGF水平较术前增高,但研究组较对照组低(P<0.05);术后两组血清SCC水平较术前降低,且研究组较对照组低(P<0.05);术后第7天及1个月研究组血清Cyclin E、TGF-α水平较对照组低(P<0.05)。结论采用超声内镜辅助内镜黏膜下切除术治疗食管癌前病变,可缩短手术用时及流质饮食时间,降低血清鳞状上皮细胞癌抗原水平,应激反应及对机体造成的损伤程度较轻,利于降低血清肿瘤标志物及遗传学分子水平。
Objective To investigate the effect of endoscopic ultrasongraphy-assisted endoscopic mucosal resection( EMR) on postoperative stress response and serum squamous cell carcinoma antigen( SCC) level in postoperative patients with esophageal precancerous lesion. Methods 76 patients with esophageal precancerous lesion in our hospital from November 2015 to June 2017 were selected and randomly divided into the control group( n = 38) and the study group( n = 38). The study group was treated with endoscopic ultrasongraphy-assisted EMR,and the control group was treated with EMR. The operative time,liquid diet time,preoperative and poatoperative immediate serum stress response index( norepinephrine,epinephrine,aldosterone,angiotensin and renin) level,serum tumor markers [Cytokeratin 19,serum fragment 21-1( CYFRA21-1),tumor specific growth factor( TSGF) ] levels and tumor specific growth factor( TSGF)〗 level,the SCC levels and serum genetic molecules at 7 d and 1 month after surgery [cyclin E( Cyclin E) and transforming growth factor-α( TGF-α) ] levels were counted. Results The operation time and fluid diet time in the study group were less than those in the control group( P < 0. 05). The levels of norepinephrine,epinephrine,aldosterone,angiotensin II and renin in the two groups were higher than those before operation,but the study group was lower than the control group( P < 0. 05). The levels of serum CYFRA21-1 and TSGF in the two groups were higher than those before operation,but the study group was lower than the control group( P < 0. 05). The level of serum SCC in two groups was lower than that before operation,and the study group was lower than that of the control group( P < 0. 05). The serum levels of Cyclin,E and TGF-in the study group were lower than those in the control group at seventh day and 1 month after operation( P < 0. 05). Conclusion Using endoscopic ultrasongraphy-assisted EMR to treat patients with esophageal precancerous lesion can reduce the operation time and feeding time,reduce the antigen levels of serum squamous cell carcinoma. The stress reaction and the degree of damage to the body are lighter. It is helpful to reduce the leakage of tumor markers and genetic molecular.
Objective To investigate the effect of endoscopic ultrasongraphy-assisted endoscopic mucosal resection( EMR) on postoperative stress response and serum squamous cell carcinoma antigen( SCC) level in postoperative patients with esophageal precancerous lesion. Methods 76 patients with esophageal precancerous lesion in our hospital from November 2015 to June 2017 were selected and randomly divided into the control group( n = 38) and the study group( n = 38). The study group was treated with endoscopic ultrasongraphy-assisted EMR,and the control group was treated with EMR. The operative time,liquid diet time,preoperative and poatoperative immediate serum stress response index( norepinephrine,epinephrine,aldosterone,angiotensin and renin) level,serum tumor markers [Cytokeratin 19,serum fragment 21-1( CYFRA21-1),tumor specific growth factor( TSGF) ] levels and tumor specific growth factor( TSGF)〗 level,the SCC levels and serum genetic molecules at 7 d and 1 month after surgery [cyclin E( Cyclin E) and transforming growth factor-α( TGF-α) ] levels were counted. Results The operation time and fluid diet time in the study group were less than those in the control group( P < 0. 05). The levels of norepinephrine,epinephrine,aldosterone,angiotensin II and renin in the two groups were higher than those before operation,but the study group was lower than the control group( P < 0. 05). The levels of serum CYFRA21-1 and TSGF in the two groups were higher than those before operation,but the study group was lower than the control group( P < 0. 05). The level of serum SCC in two groups was lower than that before operation,and the study group was lower than that of the control group( P < 0. 05). The serum levels of Cyclin,E and TGF-in the study group were lower than those in the control group at seventh day and 1 month after operation( P < 0. 05). Conclusion Using endoscopic ultrasongraphy-assisted EMR to treat patients with esophageal precancerous lesion can reduce the operation time and feeding time,reduce the antigen levels of serum squamous cell carcinoma. The stress reaction and the degree of damage to the body are lighter. It is helpful to reduce the leakage of tumor markers and genetic molecular.
引文
[1]任重,钟芸诗,周平红,等.内镜下黏膜多环套扎切除术治疗食管癌前病变和食管早癌的近期疗效和安全性分析[J].中华胃肠外科杂志,2013,16(5):425-428.
[2]Coleman HG,Murray LJ,Hicks B,et al.Dietary fiber and the risk of precancerous lesions and cancer of the esophagus:a systematic review and meta-analysis[J].Nutr Rev,2013,71(7):474-482.
[3]王晓燕,樊元春.食管癌伴E-NED的临床病理特点及诊断标志物探讨[J].临床和实验医学杂志,2016,15(11):1089-1092,1093.
[4]崔少波.内镜黏膜下剥离术治疗食管癌前病变及早期食管癌研究[J].中国中西医结合消化杂志,2017,25(6):466-468.
[5]刘树青,任重,钟芸诗,等.内镜下黏膜多环套扎切除术治疗食管癌前病变和早癌并发症的防治[J].中华胃肠外科杂志,2013,16(12):1151-1154.
[6]李红平,唐波,樊超强,等.内镜黏膜下剥离术治疗近环周早期食管癌及癌前病变的价值[J].第三军医大学学报,2014,36(3):278-282.
[7]熊英,李元平,袁志刚,等.隧道法内镜黏膜下剥离术在食管早期癌及癌前病变中应用的研究[J].临床消化病杂志,2013,25(2):67-69.
[8]陈远博,赵妙,晏洁影,等.窄带成像技术联合超声内镜对早期食管癌及癌前病变的诊治价值[J].中国临床研究,2015,28(8):996-999.
[9]Wani S,Das A,Rastogi A,et al.Endoscopic ultrasonography in esophageal cancer leads to improved survival rates:results from a population-based study[J].Cancer,2015,121(2):194-201.
[10]尔丽绵,张立玮,徐志彬,等.超声小探头对高发区早期食管癌及癌前病变术前治疗的评估及其影响因素[J].中国内镜杂志,2013,19(3):239-242.
[11]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:290-293.
[12]Behrens A,May A,Manner H,et al.Esophageal precancerous lesions:early diagnosis,treatment,and preservation of quality of life[J].Internist,2013,54(6):683-690.
[13]黄楚坚,李桦,陈于平.老年食管癌患者外科治疗的临床特征及预后因素[J].中国老年学杂志,2016,36(19):4784-4787.
[14]Liberman M,Hanna N,Duranceau A,et al.Endobronchial ultrasonography added to endoscopic ultrasonography improves staging in esophageal cancer[J].Ann Thorac Surg,2013,96(1):232-236.
[15]嵇贝纳,熊文坚,杨湘怡.超声内镜、染色法及窄带成像技术联合使用对早期食管癌的诊断价值[J].临床和实验医学杂志,2015,14(7):598-600.
[16]张东丽,孔宏芳,伏亦伟.内镜黏膜下剥离术治疗早期食管癌和癌前病变的安全性分析[J].临床内科杂志,2015,32(11):772-774.
[17]郑光华.内镜黏膜下剥离术对早期食管癌及癌前病变治疗的可行性及疗效研究[J].中国临床实用医学,2016,7(4):25-27.
[18]Ripley RT,Sarkaria IS,Grosser R,et al.Pretreatment dysphagia in esophageal cancer patients may eliminate the need for staging by endoscopic ultrasonography[J].Ann Thorac Surg,2015,101(1):226-230.
[19]李雪平,张振华,任红霞,等.超声内镜在微创诊治食管疾病中的应用进展[J].医学综述,2015,21(18):3368-3370.
[20]Hulshoff JB,Mul VEM,Boer HEM,et al.Impact of Endoscopic Ultrasonography on 18 F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment[J].Ann Surg Oncol,2017,24(7):1828-1834.
[21]郏建臣,段秀芳.超声内镜辅助下内镜黏膜下剥离术治疗食管癌前病变的临床研究[J].中国内镜杂志,2015,21(4):348-351.
[22]曹红,江华.血清鳞状上皮细胞癌相关抗原、癌胚抗原、神经元特异性烯醇化酶及细胞角蛋白19片段抗原检测在食管癌诊断中的价值[J].中国医药导报,2013,10(14):96-97.
[23]Sugimura K,Miyata H,Motoori M,et al.The significance of SCC and CEA mRNA in the pleural cavity after lymphadenectomy in esophageal cancer patients who underwent preoperative treatment[J].World J Surg,2017,5(1):1-9.
[24]刘晓波,高子夜,金曙,等.内镜下多环黏膜切除术在治疗早期食管癌及癌前病变中的应用价值[J].湖北医药学院学报,2014,33(5):441-443,447,封2.
[25]郭大昕,杨建民,徐启顺,等.内镜黏膜下剥离术和内镜下黏膜切除术治疗早期食管癌安全有效性的Meta分析[J].中华消化内镜杂志,2013,30(12):685-689.
[2]Coleman HG,Murray LJ,Hicks B,et al.Dietary fiber and the risk of precancerous lesions and cancer of the esophagus:a systematic review and meta-analysis[J].Nutr Rev,2013,71(7):474-482.
[3]王晓燕,樊元春.食管癌伴E-NED的临床病理特点及诊断标志物探讨[J].临床和实验医学杂志,2016,15(11):1089-1092,1093.
[4]崔少波.内镜黏膜下剥离术治疗食管癌前病变及早期食管癌研究[J].中国中西医结合消化杂志,2017,25(6):466-468.
[5]刘树青,任重,钟芸诗,等.内镜下黏膜多环套扎切除术治疗食管癌前病变和早癌并发症的防治[J].中华胃肠外科杂志,2013,16(12):1151-1154.
[6]李红平,唐波,樊超强,等.内镜黏膜下剥离术治疗近环周早期食管癌及癌前病变的价值[J].第三军医大学学报,2014,36(3):278-282.
[7]熊英,李元平,袁志刚,等.隧道法内镜黏膜下剥离术在食管早期癌及癌前病变中应用的研究[J].临床消化病杂志,2013,25(2):67-69.
[8]陈远博,赵妙,晏洁影,等.窄带成像技术联合超声内镜对早期食管癌及癌前病变的诊治价值[J].中国临床研究,2015,28(8):996-999.
[9]Wani S,Das A,Rastogi A,et al.Endoscopic ultrasonography in esophageal cancer leads to improved survival rates:results from a population-based study[J].Cancer,2015,121(2):194-201.
[10]尔丽绵,张立玮,徐志彬,等.超声小探头对高发区早期食管癌及癌前病变术前治疗的评估及其影响因素[J].中国内镜杂志,2013,19(3):239-242.
[11]陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:290-293.
[12]Behrens A,May A,Manner H,et al.Esophageal precancerous lesions:early diagnosis,treatment,and preservation of quality of life[J].Internist,2013,54(6):683-690.
[13]黄楚坚,李桦,陈于平.老年食管癌患者外科治疗的临床特征及预后因素[J].中国老年学杂志,2016,36(19):4784-4787.
[14]Liberman M,Hanna N,Duranceau A,et al.Endobronchial ultrasonography added to endoscopic ultrasonography improves staging in esophageal cancer[J].Ann Thorac Surg,2013,96(1):232-236.
[15]嵇贝纳,熊文坚,杨湘怡.超声内镜、染色法及窄带成像技术联合使用对早期食管癌的诊断价值[J].临床和实验医学杂志,2015,14(7):598-600.
[16]张东丽,孔宏芳,伏亦伟.内镜黏膜下剥离术治疗早期食管癌和癌前病变的安全性分析[J].临床内科杂志,2015,32(11):772-774.
[17]郑光华.内镜黏膜下剥离术对早期食管癌及癌前病变治疗的可行性及疗效研究[J].中国临床实用医学,2016,7(4):25-27.
[18]Ripley RT,Sarkaria IS,Grosser R,et al.Pretreatment dysphagia in esophageal cancer patients may eliminate the need for staging by endoscopic ultrasonography[J].Ann Thorac Surg,2015,101(1):226-230.
[19]李雪平,张振华,任红霞,等.超声内镜在微创诊治食管疾病中的应用进展[J].医学综述,2015,21(18):3368-3370.
[20]Hulshoff JB,Mul VEM,Boer HEM,et al.Impact of Endoscopic Ultrasonography on 18 F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment[J].Ann Surg Oncol,2017,24(7):1828-1834.
[21]郏建臣,段秀芳.超声内镜辅助下内镜黏膜下剥离术治疗食管癌前病变的临床研究[J].中国内镜杂志,2015,21(4):348-351.
[22]曹红,江华.血清鳞状上皮细胞癌相关抗原、癌胚抗原、神经元特异性烯醇化酶及细胞角蛋白19片段抗原检测在食管癌诊断中的价值[J].中国医药导报,2013,10(14):96-97.
[23]Sugimura K,Miyata H,Motoori M,et al.The significance of SCC and CEA mRNA in the pleural cavity after lymphadenectomy in esophageal cancer patients who underwent preoperative treatment[J].World J Surg,2017,5(1):1-9.
[24]刘晓波,高子夜,金曙,等.内镜下多环黏膜切除术在治疗早期食管癌及癌前病变中的应用价值[J].湖北医药学院学报,2014,33(5):441-443,447,封2.
[25]郭大昕,杨建民,徐启顺,等.内镜黏膜下剥离术和内镜下黏膜切除术治疗早期食管癌安全有效性的Meta分析[J].中华消化内镜杂志,2013,30(12):685-689.
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