早期食管癌及上皮内瘤变内镜黏膜下剥离术后食管狭窄的危险因素

Risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal carcinoma and intraepithelial neoplasia

目的探讨早期食管癌及上皮内瘤变行内镜黏膜下剥离术(ESD)后发生狭窄的危险因素,为临床防治狭窄提供依据。方法将2015年1月至2020年12月,在中国人民解放军联勤保障部队第九六〇医院行早期食管癌及上皮内瘤变ESD治疗的155例患者纳入回顾性分析。收集患者一般资料、病变特征、手术及食管狭窄发生情况等资料,用单变量和多变量Logistic回归分析ESD术后狭窄的相关危险因素。结果155例患者中23例(14.8%)出现食管狭窄,多因素分析表明,ESD术后食管狭窄与病变环周范围>3/4、肿瘤浸润深度m3~sm1、病变纵向长径≥50 mm、食管内镜黏膜切除术(EMR)/ESD病史显著相关。结论病变环周范围>3/4、肿瘤浸润深度m3~sm1、病变纵向长径≥50 mm、食管EMR/ESD病史是ESD术后食管发生狭窄的独立危险因素。

Objective To explore the risk factors of stenosis after endoscopic submucosal dissection(ESD)for early esophageal cancer and intraepithelial neoplasia,and to provide basis for clinical prevention and treatment of stenosis.Methods From January 2015 to December 2020,155 patients with early esophageal cancer and intraepithelial neoplasia treated with ESD in the 960th Hospital of the PLA Joint Logistics Support Force were retrospectively analyzed.The general data,lesion characteristics,operation and the occurrence of esophageal stricture were collected,and the risk factors of stricture after ESD were analyzed by univariate and multivariate Logistic regression.Results Of 155 patients,esophageal stricture occurred in 23 patients(14.8%).Multivariate analysis showed that esophageal stricture after ESD was significantly correlated with circumferential lesion area>3/4,tumor invasion depth m3-sm1,lesion longitudinal diameter≥50 mm and esophageal endoscopic mucosal resection(EMR)/ESD history.Conclusion The independent risk factors of esophageal stricture after ESD are circumferential lesion area>3/4,depth of tumor invasion m3-sm1,longitudinal diameter of lesion≥50 mm and history of esophageal EMR/ESD.