自体黏膜移植预防早期食管癌近环周内镜下黏膜剥离术后食管狭窄的疗效观察

Observation of the efficacy of autologous mucosal transplantation to prevent esophageal stricture after near-circumferential endoscopic submucosal dissection for early esophageal cancer

目的探讨自体黏膜移植预防早期食管癌近环周内镜下黏膜剥离术(ESD)后食管狭窄的疗效。方法回顾性分析2017年4月至2022年7月在郑州大学第一附属医院行早期食管癌近环周ESD并定期随访的33例患者的病例资料,男14例,女19例,年龄(66.4±7.4)(47~77)岁。根据治疗方式不同,共分为4组:A组6例,术后行自体黏膜移植术及全覆膜金属支架置入术,并联合口服、静脉应用及局部注射激素;B组8例,术后行自体黏膜移植术及全覆膜金属支架置入术;C组11例,术后行全覆膜金属支架置入术联合口服或静脉应用激素;D组8例,术后行全覆膜金属支架置入术。术后通过内镜观察移植黏膜生长情况、有无食管狭窄及手术并发症等,了解自体黏膜移植预防早期食管癌近环周ESD后食管狭窄的疗效。结果33例患者胃镜手术过程顺利。B、C和D组扩张次数均比A组多,A组扩张次数[M(Q_(1),Q_(3))]为0(0,1.8)次,B、C和D组扩张次数分别为5.5(4.3,6.8)、4.0(4.0,7.0)和5.5(3.5,10.8)次,差异均有统计学意义(均P<0.05);B、C和D组各组间扩张次数差异均无统计学意义(均P>0.05)。B组支架放置时间[M(Q_(1),Q_(3))][7.5(6.3,8.8)d]比A组[64.5(41.5,75.5)d]短(P=0.006);C组[38.0(28.0,50.0)d]和D组[31.5(27.3,66.3)d]支架放置时间与A组相比差异均无统计学意义(均P>0.05);C组支架放置时间长于B组(P<0.05);B和C组支架放置时间与D组相比差异均无统计学意义(均P>0.05)。各组间并发症发生情况差异均无统计学意义(均P>0.05)。结论自体黏膜移植预防早期食管癌近环周ESD后狭窄是安全有效的,其联合全覆膜金属支架置入、全身及局部激素应用时预防效果比单独应用时好。

Objective To investigate the efficacy of autologous mucosal transplantation to prevent esophageal stricture after near-circumferential endoscopic submucosal dissection(ESD)for early esophageal cancer.Methods The case data of 33 patients,who underwent near-circumferential ESD for early esophageal cancer and were followed up regularly in the First Affiliated Hospital of Zhengzhou University from April 2017 to July 2022,were analyzed retrospectively,including 14 males and 19 females,aged(66.4±7.4)(47-77)years.According to the different treatment methods,they were divided into 4 groups:group A(6 cases)were treated with autologous mucosa transplantation and fully covered metal stent implantation,combined with oral,intravenous and local injection of hormone;Group B(8 cases)were treated with autologous mucosa transplantation and fully covered metal stent implantation;Group C(11 cases)were treated with fully covered metal stent implantation combined with oral or intravenous hormone;Group D(8 cases)were treated with fully covered metal stent implantation.After the operation,the growth of the transplanted mucosa,esophageal stricture and surgical complications were observed by endoscopy,so as to understand the efficacy of automucosa transplantation in preventing esophageal stricture after near-circumferential ESD for early esophageal cancer.Results The gastroscopic operation was successful in 33 patients.The times of expansion in groups B,C and D were more than that in group A,and the times of expansion[M(Q_(1),Q_(3))]in group A were 0(0,1.8)times,while the times of expansion in group B,C and D were 5.5(4.3,6.8),4.0(4.0,7.0)and 5.5(3.5,10.8)times,respectively,with statistical significance(all P<0.05).There was no significant difference in times of expansion among groups B,C and D(all P>0.05).The stent placement time[M(Q_(1),Q_(3))]in group B[7.5(6.3,8.8)days]was shorter than that in group A[64.5(41.5,75.5)days](P=0.006).There was no significant difference in stent placement time between group C[38.0(28.0,50.0)days]and group D[31.5(27.3,66.3)days]and group A(both P>0.05).The stent placement time in group C was longer than that in group B(P<0.05).There was no significant difference in stent placement time between group B,C and D(all P>0.05).There was no significant difference in the incidence of complications among the groups(all P>0.05).Conclusions Autologous mucosal transplantation is safe and effective in preventing stenosis after near-circumferential ESD for early esophageal cancer.The effect of autologous mucosal transplantation combined with fully covered metal stent placement,systemic and local steroid application in preventing esophageal stricture after near-circumferential ESD for early esophageal cancer is better than that of single application.