早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术后非治愈性切除的危险因素探讨

Discussion of risk factors for non-curative resection after endoscopic submucosal dissection for early esophageal cancer and high-grade intraepithelial neoplasia

目的探讨早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术(ESD)后非治愈性切除的危险因素。方法回顾性分析南京医科大学附属淮安第一医院消化内科收治的153例行ESD的早期食管癌和高级别上皮内瘤变患者的临床资料,根据术后病理结果,分为治愈性切除组和非治愈性切除组,对可能影响非治愈性切除的相关因素进行多因素分析。结果早期食管癌、病变黏膜下浸润和术中抬举征欠佳为早期食管癌和高级别上皮内瘤变行ESD后非治愈性切除的危险因素(P <0.05)。多因素分析显示,病变为早期食管癌、存在黏膜下浸润为早期食管癌和高级别上皮内瘤变行ESD后非治愈性切除的独立危险因素(P <0.05)。结论早期食管癌、病变黏膜下浸润、术中抬举征欠佳为早期食管癌和高级别上皮内瘤变行ESD后非治愈性切除的危险因素,其中早期食管癌和存在黏膜下浸润为非治愈性切除的独立危险因素。

Objective To investigate the possible risk factors for non-curative resection after endoscopic submucosal dissection for early esophageal cancer and high-grade intraepithelial neoplasia.Methods The clinical data of 153 patients with early esophageal cancer and high-grade intraepithelial neoplasia treated by endoscopic submucosal dissection were retrospectively analyzed.According to the postoperative pathological results,they were divided into the curative resection group and non-curative resection group,and a multivariate analysis was performed to determine the factors that might influence noncurative resection.Results Early esophageal cancer,submucosal infiltration of the lesion,and poor intraoperative lesion lift were risk factors for non-curative resection after ESD for early esophageal cancer and high-grade intraepithelial neoplasia(P<0.05).Multivariate analysis showed that the lesions were early esophageal cancer,the existence of submucosal infiltration was the independent risk factors for non-curative resection after ESD for early esophageal cancer and high-grade intraepithelial neoplasia(P<0.05).Conclusion Early esophageal cancer,submucosal invasion of the lesion,and poor intraoperative lesion lift are risk factors for non-curable resection after early esophageal cancer and high-grade intraepithelial neoplasia.Among them,early esophageal cancer and the presence of submucosal infiltration were independent risk factors for non-curative resection.