内镜黏膜下剥离术对早期食管癌的疗效及术后难治性狭窄的影响因素分析

Efficacy of Endoscopic Submucosal Dissection for Early Esophageal Cancer and Influencing Factors of Postoperative Refractory Stenosis

目的 探讨内镜黏膜下剥离术(ESD)治疗早期食管癌的疗效及术后难治性狭窄的影响因素。方法 回顾性分析早期食管癌患者80例的临床资料,所有患者均进行ESD治疗,观察ESD治疗情况。根据患者术后是否发生难治性狭窄将患者分为发生组与未发生组,统计两组一般资料,分析早期食管癌ESD术后难治性狭窄的影响因素。结果 80例食管癌患者中,术后有18例发生难治性狭窄,发生率为22.50%(18/80);发生组肿瘤浸润深度(M3-SM2)、剥离纵径长度≥5 cm、固有肌层损伤、术中止血夹数量>5个占比均高于未发生组,差异有统计学意义(P<0.05);两组性别、年龄、吸烟史、家族史、糖尿病史相比,差异无统计学意义(P>0.05);Logistic回归分析:肿瘤浸润深度(M3-SM2)、剥离纵径长度≥5 cm、固有肌层损伤、术中止血夹数量>5个是早期食管癌ESD术后发生难治性狭窄的独立危险因素(P<0.05且OR≥1)。结论 早期食管癌患者采用ESD术治疗效果确切,但术后难治性狭窄发生率较高,肿瘤浸润深度(M3-SM2)、剥离纵径长度≥5 cm、固有肌层损伤、术中止血夹数量>5个是其独立影响因素,临床需予以高度重视。

Objective To investigate the efficacy of endoscopic submucosal dissection(ESD) in the treatment of early esophageal cancer and the influencing factors of postoperative refractory stenosis.Methods 80 clinical data of early esophageal cancer patients were retrospectively analyzed,and all patients underwent ESD to observe ESD treatment.Patients were divided into occurrence and untreated groups according to whether and not,two general data were counted,and the influencing factors of refractory stenosis after ESD of early esophageal cancer were analyzed.Results Of the 80 patients with oesophageal cancer,18 postoperative cases had refractory stenosis,The incidence rate was 22.50%(18/80);The proportion of the depth of tumor infiltration(M3-SM2),the longitudinal diameter length ≥5 cm,muscularis propria injury,the number of intraoperative hemostasis clips 5 were higher than that of the untreated group,The difference was significant(P<0.05);Compared to gender,age,smoking history,family history,and diabetes history,There was no significant difference(P>0.05);Logistic regression analysis showed that depth of tumor invasion(M3-SM2),length of stripped longitudinal diameter ≥5 cm,muscularis propria injury,and number of intraoperative hemostatic clips >5 were independent risk factors for refractory stenosis after ESD of early esophageal cancer(P<0.05 and OR 1).Conclusion ESD is effective for early esophageal cancer,but with high incidence of postoperative refractory stenosis,tumor invasion(M3-SM2),Length of stripped longitudinal diameter ≥5 cm,muscularis propria injury,and intraoperative hemostatic clips >5,are the independent factors.