早期食管鳞状细胞癌及癌前病变内镜黏膜下剥离术后切缘阳性的危险因素分析

Risk factors of positive incision margin after ESD for early esophageal squamous cell carcinoma and precancerous lesions

[目的]研究早期食管鳞状细胞癌(esophageal squamous cell carcinoma, ESCC)及癌前病变行内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)后切缘阳性的相关危险因素及其预后情况。[方法]对因早期ESCC和(或)癌前病变行ESD后患者的临床病理资料行回顾性研究。根据术后病理组织切缘是否阳性,分为切缘阳性组和切缘阴性组,收集2组患者临床、内镜、病理学结果,分析术后切缘阳性发生的危险因素和预后情况。[结果]共纳入患者88例,切除病灶99处,切缘阴性85处,切缘阳性14处,切缘阳性率为14.14%(14/99),局部复发率为1.01%(1/99)。单因素分析提示,2组手术时间、术后并发症、标本长度、环周面积、钳检组织学异同、病理类型比较差异有统计学意义。切缘阳性组内镜随访,追加手术3例,术后病检均未发现淋巴结转移;1例在随访9个月后发现复发并有新发病灶,再次行ESD。[结论]标本长度和病理类型是ESCC及癌前病变ESD术后切缘阳性的独立危险因素,临床医生需严格把控适应证,加强ESD术中、术后的质量管理。

[Objective]To study the risk factors and prognosis of positive incisal margin in early esopha-geal squamous cell carcinoma(ESCC)after endoscopic submucosal dissection(ESD).[Methods]From Janu-ary 1,2016 to December 31,2020,patients with early ESCC and/or precancerous lesions underwent ESD surgery in Gastroenterology Department of Taihe hospital were retrospectively studied.According to whether the margin of postoperative pathological tissue was positive or not,the patients were divided into two groups:positive margin group and negative margin group.The clinical,endoscopic and pathological re-sults of the two groups were collected,and the risk factors and prognosis of positive margin after operation were analyzed.[Results]Among 88 patients,99 lesions were removed,85 were negative and 14 were posi-tive.The positive rate of the margin was 14.14%(14/99),and the local recurrence rate was 1.01%(1/99).Univariate analysis showed that there were significant differences in operation time,postoperative compli-cations,specimen length,circumferential area,histological differences and pathological types between the two groups.Endoscopic follow-up in the positive incision group,3 cases were added with surgery,and no lymph node metastasis was found after operation One patient was followed up for 9 months and found to have recurrence and new lesions,and underwent ESD operation again.[Conclusion]Specimen length and pathological type are independent risk factors for positive incision margin after ESD operation for early e-sophageal squamous cell carcinoma and precancerous lesions.Clinicians should strictly control indications and strengthen quality management during and after ESD operation.