内镜黏膜下剥离术治疗大面积早期食管癌的疗效分析

Analysis of the effect of endoscopic submucosal dissection on large area of early esophageal cancer

目的探讨内镜黏膜下剥离术(ESD)治疗大面积早期食管癌的疗效。方法回顾性分析该院消化内科2013年12月-2020年12月行ESD治疗的179例病变长径大于3 cm的早期食管癌患者的临床资料,按病变长径将患者分为3组,分别为:3 cm≤d<5 cm组、5 cm≤d<7 cm组和d≥7 cm组。分析3组患者手术安全性(迟发穿孔率、气体相关并发症发生率、术后出血率和狭窄率)及有效性(整块切除率、治愈性切除率和局部复发率)的差异。结果3组患者迟发性穿孔率均为0.00%,3 cm≤d<5 cm组、5 cm≤d<7 cm组和d≥7 cm组气体相关并发症发生率分别为5.21%、8.33%和13.04%,出血率分别为1.04%、3.33%和8.70%,整块切除率分别为98.96%、95.00%和91.30%,3组患者气体相关并发症发生率、术后出血率和整块切除率比较,差异均无统计学意义(P>0.05);3组患者病变狭窄率分别为9.38%、23.33%和47.83%,差异有统计学意义(P<0.05)。3 cm≤d<5 cm组和5 cm≤d<7 cm组中,治愈性切除率分别为95.83%和85.00%,局部复发率分别为3.13%和11.67%,两组患者比较,差异均有统计学意义(P<0.05)。5 cm≤d<7 cm组和d≥7 cm组中,治愈性切除率分别为85.00%和69.57%,局部复发率分别为11.67%和21.74%,两组患者比较,差异均无统计学意义(P>0.05)。结论ESD治疗大面积早期食管癌,病变长度在3~7 cm之间时,有效性及安全性高,治愈性切除率与病变直径呈反比,局部复发率与病变直径呈正比;d≥7 cm组治疗有效性较低,对于该类病变需谨慎评估病变范围、深度和狭窄风险。

Objective To investigate the efficacy of endoscopic submucosal dissection(ESD)in treatment of large area early esophageal cancer.Methods Retrospectively analyzed the data of 179 patients with large-area early esophageal cancer from December 2013 to December 2020.Then analyzed the safety(late perforation rate,gas related complications,bleeding rate,stenosis rate)and effectiveness(en bloc resection rate,curable resection rate,local recurrence rate)of ESD treatment with different layers.Result The 3 cm≤d<5 cm group,5 cm≤d<7 cm group and d≥7 cm group in late-onset perforation rate of 0.00%,gas related complication rates were 5.21%,8.33%and 13.04%,and bleeding rates were 1.04%,3.33%and 8.70%respectively,the en bloc resection rate were 98.96%,95.00%and 91.30%,the difference of gas related complications rate,bleeding rate,the en bloc rate in three groups had no statistical significance(P>0.05);The stenosis rates of the three groups were 9.38%,23.33%and 47.83%,respectively,and the stenosis rate increased with the increase of the diameter and length of the lesions,with statistical significance(all P<0.05).In 3 cm≤d<5 cm group and 5 cm≤d<7 cm group,the curative resection rates were 95.83%and 85.00%,respectively,which decreased with the increase of lesion,and the local recurrence rates were 3.13%and 11.67%,respectively,which increased with the increase of lesion diameter,with statistical significance(all P<0.05).There was no significant difference in curative resection rate(85.00%and 69.57%)and local recurrence rate(11.67%and 21.74%)between 5 cm≤d<7 cm group and d≥7 cm group(all P>0.05).Conclusion ESD is effective and safe in the treatment of large area of early esophageal cancer,the length of the lesion is between 3~7 cm.The curative resection rate is inversely proportional to the diameter of the lesion,and the local recurrence rate is positively proportional to the diameter of the lesion.d≥7 cm group has low efficacy,and the lesion scope,depth,and stenosis risk should be carefully evaluated for this type of lesion.