ESD治疗食管、胃癌前病变及早期癌症的疗效及其并发症的影响因素

Risk Factors for the Efficacy and Complications of ESD in the Treatment of Esophageal and Gastric Precancerous Lesions and Early Cancer

目的探讨上消化道癌前病变及早期癌症患者内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)的疗效及其并发症的影响因素。方法纳入2017-01/2021-01月在作者医院进行ESD治疗的276例食管、胃癌前病变及早期癌症患者,以完全性切除和治愈性切除为治疗成功,以非治愈性切除为治疗失败,评价ESD疗效。出血、消化道狭窄和穿孔3项为并发症。对患者的一般资料进行单因素分析,采用Logistic回归分析探讨疗效和影响并发症发生危险因素。结果276例患者中230例(83.33%)完整切除,6例(2.17%)患者治愈性切除,治疗成功率为85.51%,40例(14.49%)患者术后病理显示切缘阳性为非治愈性切除。术后3年生存率99.25%,复发率0.75%;出血、消化道狭窄和穿孔发生率分别为7.97%、5.07%、2.90%。单因素和Logistic回归分析表明病变直径(≥3 cm)、浸润深度(M3、SM1)、胃部溃疡是影响ESD疗效的重要因素(P<0.05);浸润深度(M3、SM1)、贲门-胃底和病变直径(≥3 cm)是出血的危险因素,病变直径(≥3 cm)和浸润深度(M3、SM1)是消化道狭窄的影响因素(P<0.05)。单因素分析表明,穿孔与未穿孔患者在病变直径、浸润深度、胃部病变(细分)上差异有统计学意义(P<0.05)。结论病变直径和浸润深度是影响食管和胃癌前病变及早期癌症ESD疗效以及并发症的主要因素,此外贲门-胃底患者围术期应注意出血风险。

Objective To investigate the risk factors for the efficacy and complications of endoscopic submucosal dissection(ESD)in the treatment of early carcinoma of upper digestive tract and precancerous lesion.Methods A total of 276 patients of early carcinoma of the esophagus and stomach and precancerous lesions who underwent ESD in author′s hospital from January 2017 to January 2021 were selected,and the efficacy of ESD was evaluated by complete resection and curative resection were counted as success and non curative resection was counted as failure.Bleeding,digestive tract stenosis and perforation were 3 complications.Univariate analysis was performed on the general data of the patients,and the efficacy and risk factors of complications were explored by Logistic regression analysis.Results In the 276 cases,230 cases of patients were completely excised(83.33%),6 were cured(2.17%)and the success rate was 85.51%,40 patients(14.49%)showed positive resection margin after operation.The 3 year survival rate was 99.25%,the recurrence rate was 0.75%;the incidence of bleeding,digestive tract stenosis and perforation were 7.97%,5.07%and 2.90%respectively.Univariate and Logistic regression analysis showed that the diameter of the lesion(≥3 cm),depth of invasion(M3,SM1),and gastric ulcer were important factors affecting the efficacy of ESD(P<0.05);infiltration depth(M3,SM1),cardia fundus and lesion diameter(≥3 cm)were risk factors for bleeding,and the lesion diameter(≥3 cm)and depth of infiltration(M3,SM1)were the factors affecting the digestive tract stenosis(P<0.05).Univariate analysis showed that there were significant differences in lesion diameter,infiltration depth and gastric lesion(subdivision)between perforated and unperforated patients(P<0.05).ConclusionThe lesion diameter and infiltration depth are the main factors affecting the ESD efficacy and complications of esophageal and gastric precancerous lesion and early cancer.In addition,patients with cardia fundus should pay attention to the risk of bleeding during perioperative period.