上消化道浅表癌患者ESD术中水平切缘阳性的相关因素分析

Analysis of Related Factors for Positive Horizontal Margin in ESD Surgery in Patients with Superficial Carcinoma of Upper Digestive Tract

目的:分析上消化道浅表癌患者内镜黏膜下剥离术(ESD)术中采集标本出现水平切缘阳性的相关因素。方法:回顾性分析某院收治的170例上消化道浅表癌患者临床资料,根据患者ESD术中所采集标本水平切缘情况检查结果分为A组(水平切缘阳性,n=39)和B组(水平切缘阴性,n=131),分析患者ESD术中所采集标本水平切缘阳性与其基本资料、实验室指标、治疗情况的关系,采用多因素Logistic回归分析方法分析ESD术中水平切缘阳性发生的相关因素。结果:A组与B组病变累及管周范围、浸润深度、标本面积、术中标记前碘染、术后病理诊断情况有明显差异,且差异均有统计学意义(P<0.05),其中,病变累及管周范围≥0.75管周、浸润深度M_(3)以深、标本面积大是食管浅表癌患者行ESD手术标本发生水平切缘阳性的独立危险因素,术中标记前进行碘染为保护因素。结论:临床行ESD术前需重视病灶面积、累及范围、浸润深度评估,给予患者碘染,对于严重者应结合白光及窄带放大内镜(ME-NBI)进行综合评估,从而进行积极防治,保证良好预后。

Objective:To analyze the related factors for positive horizontal margin in endoscopic submucosal dissection(ESD)surgry in patients with superficial carcinoma of upper gastrointestinal tract.Methods:The clinical data of 170 cases of patients with superficial carcinoma of upper digestive tract in a hospital were retrospectively analyzed.According to the inspection results of the horizontal margins of samples collected in ESD surgery were divided into group A positive(horizontal margin,n=39)and group B(negative horizontal margin,n=131).The relationship between positive horizontal margin of specimens collected in ESD sgurgery and their basic data,laboratory indicators and treatment situation was analyzed.The multivariate Logistic regression analysis method was used to analyze the actors related to the occurrence of positive horizontal margins during ESD surgery.Results:There was statistically significant difference in the lesions involved the peritubular range,infiltration depth,specimen size,iodine staining before intraoperative labeling,postoperative pathological diagnosis condition between the group A and group B(P<0.05).Among them,the lesions involved the peritubular range≥0.75 weeks,infiltration depth M_(3) deep and large specimen area were the independent risk factors for positive horizontal margins in ESD surgical specimens in patients with superficial esophageal cancer,and the iodine staining before intraoperative labeling was protective factor.Conclusion:Before clinical ESD,attention should be paid to the assessment of lesion area,involvement range and depth of invasion,iodine staining should be given to patients,and white light and narrow band magnifying endoscopy(ME-NBI)should be combined for comprehensive evaluation in severe cases,so as to actively prevent and cure,and ensure good prognosis.