老年食管早癌内镜黏膜下剥离术后狭窄的危险因素分析

Analysis of high risk factors of stenosis after endoscopic submucosal dissection of early esophageal cancer in the elderly patients

[目的]分析食管早癌内镜黏膜下剥离术后狭窄的高危因素。[方法]选择行内镜黏膜下剥离术治疗的老年食管早癌患者239例,观察内镜黏膜下剥离术后狭窄发生情况。对患者性别、糖尿病史、高血压史、吸烟史、饮酒史、病灶部位、病变直径、病变形态、浸润深度、血小板淋巴细胞比值(platelet-lymphocyte ratio, PLR)、中性淋巴细胞比值(neutral lymphocyte ratio, NLR)与术后狭窄的关系采用多因素Logistic回归分析。[结果]239例中术后狭窄37例,发生率为15.48%。经单因素分析表明,术后狭窄组与术后无狭窄组性别、糖尿病史、高血压史、吸烟史、饮酒史、病灶部位和浸润深度比较差异无统计学意义(P>0.05);术后狭窄组与术后无狭窄组病变直径、病变深度、PLR和NLR比较差异具有统计学意义(P<0.05)。经多因素Logistic回归分析显示,病变直径>5 cm、病变深度m3+sm、高PLR和高NLR为影响术后狭窄高危因素。[结论]食管早癌内镜黏膜下剥离术后狭窄发生率较高,其中病变直径>5 cm、病变深度m3+sm、高PLR和高NLR为其高危因素。

[Objective]To analyze the high risk factors of esophageal stenosis after endoscopic submucosal dissection.[Methods]The 239elderly patients with early esophageal cancer admitted to our hospital from January 2015to December 2019were treated with endoscopic submucosal dissection.The occurrence of stenosis after endoscopic submucosal dissection was recorded.Multivariate logistic regression analysis was used to analyze the relationship between gender,diabetes history,hypertension history,smoking history,drinking history,focus location,lesion diameter,lesion shape,infiltration depth,PLR,NLR and postoperative stenosis.[Results]The 239cases of early esophageal cancer and 37cases of postoperative stenosis were treated by endoscopic submucosal dissection,the incidence of stenos is 15.48%.Single factor analysis showed that there was no significant difference in gender,diabetes history,hypertension history,smoking history,drinking history,lesion location and infiltration depth between the postoperative stenosis group and the non stenosis group(P>0.05).There was significant difference in lesion diameter,lesion depth,PLR and NLR between the postoperative stenosis group and the non stenosis group(P<0.05).Multivariate logistic regression analysis showed that the diameter of lesions>5cm,depth of lesions m3+SM,high PLR and high NLR were the high risk factors of postoperative stenosis.[Conclusion]The incidence of stenosis after endoscopic resection of early esophageal cancer is high,among which the diameter of lesion>5cm,the depth of lesion m3+SM,high PLR and high NLR are the high risk factors.