大面积食管早期癌内镜下切除术后食管狭窄的影响因素分析

Risk factors of esophageal stricture after endoscopic resection of large-area early esophageal cancer

目的探讨大面积食管早期癌(创面环周黏膜缺损程度≥3/4周)内镜下切除术(endoscopic resection,ER)术后发生食管狭窄的影响因素。方法2009年5月—2016年4月,63例在解放军总医院第一医学中心消化内镜中心行ER治疗的大面积食管早期癌病例纳入回顾性分析,按术后是否发生食管狭窄分为狭窄组(32例)和无狭窄组(31例),2组间比较行t检验或卡方检验,P<0.05的指标以及结合临床专业知识认为可能有意义的指标,一同纳入多因素Logistic回归分析。结果单因素分析发现,病变长度、创面环周黏膜缺损程度、固有肌层损伤与ER术后发生食管狭窄有关(P<0.05)。以上3个指标,连同是否采取狭窄预防措施、病理类型、是否整块切除共计6个指标一同纳入多因素Logistic回归分析,结果显示,创面环周黏膜缺损程度≥7/8周(与3/4~<7/8周者比较:P=0.028,OR=0.317,95%CI:0.114~0.884)和未采取狭窄预防措施(P=0.002,OR=0.153,95%CI:0.046~0.512)是大面积食管早期癌ER术后发生食管狭窄的独立危险因素。结论创面环周黏膜缺损程度≥7/8周是导致大面积食管早期癌ER术后发生食管狭窄的主要因素。对于大面积食管早期癌患者来说,采取适当的狭窄预防措施能有效减少ER术后食管狭窄发生。

Objective To explore the risk factors for esophageal stricture after endoscopic resection(ER)of large-area early esophageal cancer(≥3/4 circumferential mucosal defect).Methods A total of 63 cases of large-area early esophageal cancer treated with ER in the Digestive Endoscopy Center of the First Medical Center of PLA General Hospital from May 2009 to April 2016 were included in the retrospective analysis.They were divided into stricture group(32 cases)and non-stricture group(31 cases)according to the occurrence of postoperative esophageal stenosis.T-test or Chi square test was conducted to compare the indicators between the two groups.Indicators of P<0.05 and potential indicators from the clinical perspective were included in multivariate logistic regression analysis.Results Univariate analysis showed that the length of lesion,the degree of mucosal defect around the wound and the injury of muscularis propria were associated with esophageal stricture after ER(P<0.05).The above 3 indicators were included in the multivariate logistic regression analysis,together with 3 other indicators,i.e.preventive measures for stenosis,pathological type,and en bloc resection.The results showed that more than 7/8 circumferential mucosal defect around the wound(VS 3/4-<7/8 circumferential:P=0.028,OR=0.317,95%CI:0.114-0.884)and no preventive measures(P=0.002,OR=0.153,95%CI:0.046-0.512)were independent risk factors for esophageal stricture after ER of large-area early esophageal cancer.Conclusion Circumferential mucosa defect≥7/8 is the main factor leading to esophagus stricture after large-area early esophagus carcinoma.And appropriate preventive measures can effectively reduce the incidence of postoperative stenosis after ER.