内镜黏膜下剥离术、透明帽法黏膜切除术与黏膜多环套扎切除术治疗早期食管癌的临床观察

Clinical observation of endoscopic submucosal dissection,transparent hat mucosal resection and mucosal multi ring ligation resection for early esophageal cancer

目的探究内镜黏膜下剥离术(ESD)、透明帽法黏膜切除术(EMR-Cap)与黏膜多环套扎切除术(MBM)对早期食管癌及癌前病变的疗效。方法回顾性分析2017年12月至2021年12月在本院进行治内镜治疗的早期食管癌及癌前病变患者246例,其中行ESD治疗84例(ESD组)、行EMR-Cap治疗70例(EMR-Cap组)、行EMBL治疗92例(MBM组)。Kaplan-meier法绘制生存曲线。结果EMR组、EMR-Cap组、MBM组患者术后并发症发生率分别为15.48%、12.86%、8.70%,差异无统计学意义(P>0.05)。三组患者术后1年、2年无复发生存率,1年、2年、3年无局部淋巴结转移生存率,1年无远处转移生存率差异无统计学意义(P>0.05);三组患者术后3年无复发生存率差异有统计学差异(P<0.05);三组患者术后2年、3年无远处转移生存率差异有统计学差异(P<0.05)。ESD组中,随访过程中因淋巴转移发生死亡6例,死亡率为7.14%(6/84);EMR-Cap组中因淋巴转移发生死亡5例,死亡率为7.14%(5/70);MBM组中因淋巴转移发生死亡4例,死亡率为4.35%(4/92)。Kaplan-meier法显示,三组患者生存时间差异无统计学意义(P>0.05)。结论ESD、EMR-Cap及MBM均为早期食管癌及癌前病变的有效治疗方法,临床可根据患者具体病情选择手术治疗方案,以提高患者生存质量。

Objective To investigate the efficacy of endoscopic submucosal dissection(ESD),transparent cap mucosal resection(EMR-Cap),and mucosal multi ring ligation resection(MBM)in the treatment of early esophageal cancer and precancerous lesions.Methods A retrospective analysis was conducted on 246 patients with early esophageal cancer and precancerous lesions who underwent endoscopic treatment in our hospital from December 2017 to December 2021.Among them,84 patients received ESD treatment(ESD group),70 patients received EMR-Cap treatment(EMR-Cap group),and 92 patients received EMBL treatment(MBM group).Kaplan-meier method was used to draw survival curves.Results The incidence of postoperative complications in the EMR group,EMR-Cap group,and MBM group was 15.48%,12.86%,and 8.70%,respectively,with no statistically significant difference(P>0.05).There was no statistically significant difference in 1-year,2-year recurrence free survival,1-year,2-year,and 3-year local lymph node metastasis free survival,and 1-year distant metastasis free survival among the three groups of patients after surgery(P>0.05);There was a statistically significant difference in the 3-year recurrence free survival rate among the three groups of patients after surgery(P<0.05);There was a statistically significant difference in the 2-year and 3-year distant metastasis free survival rates among the three groups of patients after surgery(P<0.05).In the ESD group,there were 6 deaths due to lymphatic metastasis during follow-up,with a mortality rate of 7.14%(6/84);In the EMR-Cap group,there were 5 deaths due to lymphatic metastasis,with a mortality rate of 7.14%(5/70);There were 4 deaths due to lymphatic metastasis in the MBM group,with a mortality rate of 4.35%(4/92).The Kaplan-meier method showed no statistically significant difference in survival time among the three groups of patients(P>0.05).Conclusion ESD,EMR-Cap,and MBM are all effective treatment method for early esophageal cancer and precancerous lesions.In clinical practice,surgical treatment plans can be selected based on the patient′s specific condition to improve their quality of life.