早期食管癌内镜黏膜下剥离术后食管狭窄的危险因素分析

Risk factors of esophageal stricture after endoscopic submucosal dissection for early stage esophageal cancer

目的探讨早期食管癌内镜黏膜下剥离术（ESD）术后狭窄的危险因素，为今后预防和治疗提供研究基础。方法回顾性总结362例早期食管癌ESD患者的临床资料，统计分析临床、病理因素与术后狭窄的关系。结果发生术后狭窄42例。发生狭窄患者（狭窄组，n=42）与未发生狭窄患者（未狭窄组，n=320）在病变的纵向长度、环周直径、环周范围和组织浸润深度方面比较，差异有统计学意义（P〈0．05或P〈0．01）。选择性阶梯变量回归分析提示，病变环周范围〉3／4（OR=44．2，95％CI：4．4—443．6，P=0．0002）与组织浸润深度超过m2（OR=14．2，95％CI：2．7～74．2，P=0．0002）是ESD术后狭窄的独立危险因素。进一步分析显示，狭窄程度与病变环周范围（关联系数φ=0．47，P〈0．05）和组织浸润深度（关联系数φ=0．647，P〈0．05）存在关联。结论早期食管癌ESD术后狭窄的危险因素是病变浸润深度和环周范围，且与狭窄程度相关。

Objective To analyze the risk factors for postoperative stricture after endoscopic submucosal dissection （ESD） for early stage esophageal cancer. Methods The data of 362 patients with early esophageal cancer treated by ESD from January 2007 to February 2012 were reviewed to investigate the risk factors of postoperative stricture. Results Esophageal stricture after ESD occurred in 42 patients （ 11.6% ） with a mean time from ESD to stricture of （58.5±12. 3） days. The rates of mild, median and severe stricture were 16.7% （7/42） , 38.1% （16/42） and 45.2% （ 19/42）, respectively. Multivariate analysis revealed that lesion range 〉 3/4 esophageal circumference （odds ration [OR] ： 44.2; 95% confidence interval [CI] ： 4.4-443.6） and tumor invasion beyond m2 （ OR： 14.2; 95% CI： 2.7-74.2） were independent risk factors. Stricture level was related to lesion＇s circumferential extension （relational coefficient φ = 0. 47, P 〈 0. 05 ） and tumor invasion depth （ relational coefficient φ= 0. 647, P 〈 0. 05 ）. Conclusion Circumferential extension and invasion depth of early esophageal cancer were independent risk factors for post-ESD esophageal stricture and related with the degree of stricture.