食管癌及高级别上皮内瘤变内镜黏膜下剥离术后顽固性狭窄的危险因素分析

Analysis of risk factors for intractable stenosis after endoscopic submucosal dissection for esophageal cancer and high-grade intraepithelial neoplasia

目的研究食管癌及高级别上皮内瘤变内镜黏膜下剥离术后顽固性狭窄的危险因素。方法选择中国人民解放军联勤保障部队第九○四医院2019年3月至2021年4月收治的72例早期食管癌及高级别上皮内瘤变患者,所有患者均接受内镜黏膜下剥离术,并根据术后食管狭窄情况将其分为顽固性狭窄组(13例)与非顽固性狭窄组(59例),比较两组患者的一般资料,采用多因素Logistic回归分析患者术后顽固性狭窄的危险因素。结果72例早期食管癌及高级别上皮内瘤变患者中,术后发生顽固性狭窄13例,占18.05%。顽固性狭窄组患者肿瘤浸润深度m3~sm1、病变环周范围≥3/4及全周、病变纵向长径≥50 mm比例均高于非顽固性狭窄组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,肿瘤浸润深度m3~sm1、病变环周范围≥3/4及全周、病变纵向长径≥50 mm均为食管癌及高级别上皮内瘤变患者术后出现顽固性狭窄的危险因素(P<0.05)。结论肿瘤浸润深度较深、病变环周范围较广、病变纵向长径较长等因素均易增加食管癌患者内镜黏膜下剥离术后食管顽固性狭窄的发生率。

Objective To explore the risk factors of intractable stenosis after endoscopic submucosal dissection for esophageal cancer and high-grade intraepithelial neoplasia.Methods Seventy two patients with early esophageal cancer and high-grade intraepithelial neoplasia treated in the 904 Hospital of the joint service support force of the Chinese people's Liberation Army from March 2019 to April 2021 were selected.The basic data of the patients were collected and sorted out.All patients were given endoscopic submucosal dissection,and they were divided into intractable stenosis group(n=13)and non intractable stenosis group(n=59)according to the postoperative esophageal stenosis,analyze the risk factors of postoperative intractable stenosis.Results In this study,among 72 patients with early esophageal cancer and high-grade intraepithelial neoplasia,13 patients with refractory stenosis(refractory stenosis group),accounting for 18.05%.In the refractory stenosis group,the tumor invasion depth m3~sm1,the circumference of the lesion≥3/4,the whole circumference,and the proportion of the longitudinal length of the lesion≥50 mm were higher than those in the non-refractory stenosis group(P<0.05).Logistic analysis shows that the tumor invasion depth m3~sm1,the circumference of the lesion≥3/4 and the whole circumference,and the longitudinal diameter of the lesion≥50 mm were all patients with esophageal cancer and high-grade intraepithelial neoplasia risk factors for intractable stenosis after operation(P<0.05).Conclusion Factors such as deep tumor infiltration,wide peri lesion range and long longitudinal diameter of the lesion are easy to increase the incidence of intractable esophageal stenosis after endoscopic submucosal dissection in patients with esophageal cancer.