内镜黏膜下隧道法剥离术与传统内镜黏膜下剥离术治疗浅表性食管肿瘤的回顾性对比研究

Comparison of endoscopic submucosal tunnel dissection with endoscopic submucosal dissection for esophageal superficial neoplasms： a retrospective study

目的比较内镜黏膜下隧道法剥离术（ESTD）与传统内镜黏膜下剥离术（ESD）治疗浅表性食管肿瘤的有效性及安全性。方法对第四军医大学西京医院自2014年1月至2016年12月连续收治的行内镜治疗的浅表性食管肿瘤患者的临床资料进行回顾性分析，对ESTD与ESD的操作时间、病理结果、治疗结果及不良事件进行比较。结果共113例患者纳入研究，其中49例行ESTD治疗，64例行传统ESD治疗。ESrlD组总操作时间短于ESD组[38．0min（21．4—71．0min）比46．5min（32．5—117．5min），P=0．008]，且剥离速度明显较ESD组快[0．42cm。／min（0．22—0．59cm2／min）比0．34cm2／min（0．20-0．42cm2／min），P=0．000]。两组整块切除率均为100．0％，根治性切除率比较差异无统计学意义（98．0％比93．8％，P=0．386）。两组术后出血、穿孔、发热及胸痛的发生率差异无统计学意义，但ESTD组术中肌层损伤发生率明显低于ESD组（20．4％比39．1％，P=0．041），术中出血发生率也较ESD组低（18．4％比37．5％，P=0．036）。影响操作时间的多因素回归分析结果表明，使用ESTD方法（OR=2．801，95％凹：1．116～7．031，P=0．028）与病变面积〈9cm2（OR=5．049，95％CI：2．088—12．208，P=0．000）是缩短操作时间的独立影响因素。结论ESTD可以提高浅表性食管肿瘤治疗的有效性及安全性，可缩短操作时间、提高剥离速度并减少术中肌层损伤及出血的发生。

Objective To compare the safety and efficacy of endoscopic submucosal tunnel dissection （ESTD） and endoscopic submucosal dissection （ESD） for treatment of esophageal superficial neoplasms. Methods A retrospective study was performed on data of patients with esophageal superficial neoplasms who were treated by conventional ESD or ESTD at Xijing Hospital of Digestive Diseases between January 2014 and December 2016. The procedure time, pathology, rate of en bloc resection and curative resection, and adverse events were compared between the two groups. Results A total of 113 consecutive patients were collected, including 49 undergoing ESTD and 64 undergoing ESD. ESTD had a shorter procedure time than ESD method [ 38. 0 min（21.4-71.0 min） VS 46. 5 min （32. 5-117. 5 min）, P = 0. 008 ], and the dissection speed of ESTD was faster than that of ESD[0. 42 cm2/min（0. 22-0. 59 cm2/min） VS 0. 34 cm2/min（0. 20-0. 42 cm2/min）, P=0. 000]. There were no statistical differences in the en bloc resection rate （100. 0% VS 100. 0%, P = 1. 000） or the curative resection rate （98. 0% VS 93. 8%, P=0. 386）. There were no statistical differences on adverse event rates including post-procedure bleeding, perforation, fever, and thoracalgia. ESTD group showed a lower rate of muscular injury （ 20. 4% VS 39. 1%, P = 0. 041 ） and intra-procedure bleeding （ 18.4% VS 37.5%, P=0. 036）. A multivariate regression analysis for procedure time showed that ESTD method （OR =2. 801, 95%CI： 1. 116-7. 031, P=0. 028） and lesion area 〈9 cm2（OR= 5. 049, 95%CI： 2. 088-12. 208, P= 0. 000） were associated with a shorter procedure time. Conclusion ESTD is safe and effective for treatment of esophageal superficial neoplasms. It can shorten operative time, improve dissection speed, and reduce intraprocedure muscular layer injury and bleeding.