影响内镜黏膜下剥离术治疗上消化道早癌患者中长期预后的影响因素分析

Analysis of the Factors Influencing the Long-term Prognosis of Patients with Early Upper Gastrointestinal Cancer Treated by Endoscopic Submucosal Dissection

目的:分析影响内镜黏膜下剥离术(ESD)治疗上消化道早癌患者中长期预后的影响因素。方法:选取2019年5月—2021年5月天津市北辰医院接受治疗的100例上消化道早癌行ESD治疗的患者作为临床研究对象,进行ESD治疗后观察效果并记录资料,分析影响中长期预后的相关因素,并分析可能影响患者复发时间的影响因素。结果:ESD术后病情未复发组肿瘤浸润深度达twik膜下层、术前未行超声内镜检查、手术切缘阳性所占比例明显低于病情复发组,差异有统计学意义(P<0.05);经logistic回归分析,显示肿瘤浸润深度达黏膜下层、术前未行超声内镜检查、手术切缘阴性为病情复发的独立危险因素,差异有统计学意义(P<0.05);显示肿瘤分化程度低和肿瘤浸润深度达黏膜下层为影响复发时间的独立危险因素,差异有统计学意义(P<0.05)。结论:ESD治疗上消化道早癌临床效果较好,治愈率高,复发率低,瘤浸润深度达twik膜下层、术前未行超声内镜检查、手术切缘阴性为病情复发的独立危险因素,肿瘤分化程度低和肿瘤浸润深度达黏膜下层为影响复发时间的独立危险因素。

Objective:To analyze the factors influencing the long-term prognosis of patients with early cancer of upper diges⁃tive tract treated by endoscopic submucosal dissection(ESD).Methods:A total of 100 patients with early cancer of upper diges⁃tive tract who received ESD treatment in the hospital from May 2019 to May 2021 were selected as the clinical study objects.The effects of ESD treatment were observed and the data were recorded.The relevant factors affecting the medium and long term prog⁃nosis were analyzed,and the factors that might influence the time of relapse were analyzed.Results:The proportion of tumor infil⁃tration depth to submucosa,no endoscopic ultrasonography and positive surgical margin in the group without recurrence after ESD surgery was significantly lower than that in the group with recurrence,and the difference was statistically significant(P<0.05).Lo⁃gistic regression analysis showed that the depth of tumor infiltration reached submucosa,no endoscopic ultrasonography was per⁃formed before surgery,and the surgical margin was negative as independent risk factors for disease recurrence,with statistical sig⁃nificance(P<0.05).The low degree of tumor differentiation and the depth of tumor infiltration to submucosa were independent risk factors affecting the recurrence time,and the difference was statistically significant(P<0.05).Conclusion:ESD treatment of early cancer of upper digestive tract has good clinical effect,high cure rate,low recurrence rate,tumor infiltration depth to submucosa,no preoperative endoscopic ultrasonography,negative surgical margin are independent risk factors for recurrence,low tumor differentiation degree and tumor infiltration depth to submucosa are independent risk factors for recurrence time.