【摘要】 目的:探讨不同内镜下黏膜剥离术(ESD)手术操作方案治疗早期食管癌效果及对围术期指标、复发风险的影响与安全性。方法:选取我院2019年1月至2021年1月早期食管癌患者60例，按照随机数字表法分组，各30例。对照组采取传统ESD,观察组采取Q法自牵引技术辅助ESD(Q-ESD)。比较两组手术疗效、手术情况、手术前后创伤应激指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、皮质醇(Cor)、去甲肾上腺素(NE)]、生存质量[健康促进生活方式-Ⅱ(HPLP-Ⅱ)评分]、并发症发生率，并随访1年，对比两组术后6个月、术后1年复发率。结果:观察组整块切除率96.67%(29/30)、治愈性切除率93.33%(28/30)与对照组93.33%(28/30)、86.67%(26/30)比较差异无统计学意义(P>0.05);观察组术中失血量少于对照组，剥离速度大于对照组，剥离时间、手术时间、住院时间短于对照组(P<0.05);两组术前、术后1d、3d、5d血清TNF-α、CRP、Cor、NE水平呈先升高后下降趋势，观察组术后1d、3d、5d血清TNF-α、CRP、Cor、NE水平低于对照组(P<0.05);两组术后1个月HPLP-Ⅱ量表体育运动、健康责任、压力管理、营养、人际关系、精神成长评分较术前升高，观察组高于对照组(P<0.05);观察组并发症发生率16.67%(5/30)低于对照组40.00%(12/30)(P<0.05);观察组术后6个月、术后1年复发率0.00%(0/30)、7.14%(2/28)与对照组3.45%(1/29)、11.11%(3/27)比较差异无统计学意义(P>0.05)。结论:Q法自牵引技术辅助ESD治疗早期食管癌可明显优化手术情况，减轻手术创伤应激，促进术后恢复，还可提高生存质量，降低并发症发生率，且不增加复发风险。更多还原

【Abstract】 Objective: To investigate the effect of different endoscopic submucosal dissection(ESD) surgical procedures in the treatment of esophageal cancer in the early stage and its effect on perioperative indicators, recurrence risk and safety. Methods: Sixty patients with early-stage esophageal cancer from January 2019 to January 2021 in our hospital were selected and grouped according to the random number table method, 30 cases each. The control group adopted conventional ESD and the observation group adopted Q method self-traction technique assisted ESD(Q-ESD). The surgical efficacy, surgical condition, pre-and post-operative traumatic stress indicators [tumour necrosis factor-α(TNF-α), C-reactive protein(CRP), cortisol(Cor), norepinephrine(NE)], quality of survival [Health Promoting Lifestyle-II(HPLP-II) score], and complication rate were compared between the two groups and followed up for 1 year to compare the recurrence rates of the two groups at 6 months and 1 year post-operatively. Results: There was no statistically significant difference between the whole resection rate of 96.67%(29/30) and curative resection rate of 93.33%(28/30) in the observation group and 93.33%(28/30) and 86.67%(26/30) in the control group(P>0.05); the intraoperative blood loss in the observation group was less than that in the control group, the speed of dissection was greater than that in the control group, and the dissection time, operation time and hospital stay were shorter than control group. Serum TNF-α, CRP, Cor and NE levels in the two groups tended to increase before surgery and 1 d, 3 d and 5 d after surgery, and then decreased, while serum TNF-α, CRP, Cor and NE levels in the observation group were lower than those in the control group at 1 d, 3 d and 5 d after surgery(P<0.05). The HPLP-II scores of physical activity, health responsibility, stress management, nutrition, interpersonal relationship, and spiritual growth were higher in both groups 1 month after surgery compared to the preoperative period, and were higher in the observation group than in the control group(P<0.05); the complication rate in the observation group was 16.67%(5/30) lower than that in the control group 40.00%(12/30)(P<0.05); 6 months and 1 year after surgery in the observation group. The recurrence rates of 0.00%(0/30) and 7.14%(2/28) in the observation group were not statistically significant(P>0.05) compared with 3.45%(1/29) and 11.11%(3/27) in the control group. Conclusion: Q Method self-traction technique with ESD for early-stage oesophageal cancer significantly optimises the surgical situation, reduces surgical traumatic stress and facilitates post-operative recovery, and also improves the quality of survival and reduces complication rates without increasing the risk of recurrence.更多还原