影响早期食管癌内镜下黏膜剥离术后切缘阳性及其预后危险因素分析

A retrospective study of risk factors on affecting positive margins rate and prognosis in early esophageal cancer undergoing endoscopic submucosal dissection

[目的]分析早期食管癌内镜下黏膜剥离术(ESD)后切缘阳性的病例特点,研究其切缘阳性的危险因素。[方法]总结比较分析行ESD切除的的早期食管癌患者427例(切缘阴性390例,切缘阳性37例)的临床资料。[结果]ESD后水平切缘高级别上皮内瘤变者27例,水平切缘癌者7例,垂直切缘癌者6例。浸润深度:EP 17例,LPM 4例,MM 4例,sm110例,sm24例。Logistic回归分析显示,长度≥4 cm、范围≥2/3周、黏膜下浸润均为切缘阳性的独立危险因素。术后切缘阳性患者中,追加补救措施和单纯随访者的复发率分别为13.3%、22.7%,二者比较差异无统计学意义。上皮内肿瘤和黏膜下浅表浸润肿瘤的复发率分别为:17.4%、21.4%,二者比较差异无统计学意义。复发者中71.4%均在术后1年内复发。[结论]长度≥4 cm、范围≥2/3周及黏膜下浸润均为切缘阳性的独立危险因素。

[Objective]To evaluate the characteristics of early esophageal cancer with positive margins after endoscopic submucosal dissection.Through exploring the risk factors of positive margins after endoscopic submucosal dissection and investigating the rate of recurrence and metastasis,we expected to promoted it~'s later diagnosis and treatment.[Methods]A total of 427 early esophageal cancer underwent endoscopic submucosal dissection from 2015 to 2018 were enrolled in this retrospective study.A total of 390 patients were diagnosed as negative margin and 37 patients were diagnosed as positive margin.All of the clinical data were summarized and analyzed.[Results]The number of lateral magin with high grade intraepithelial neoplasia and cancer were 27 and 7 respectively.The number of vertical margin with cancer was 6.The infiltration depth were EP(17),LPM(4),MM(4),sm1(10),sm2(4).Logical analyses revealed that lenth≥4 cm,size≥2/3 circumference,submucosal invasion were independent risk factors for positive margin.The recurrence rate of patients received post savage treatment and patients who did not received post savage treatment were 13.3%and 22.7%,respectively,which Statistical analysis showed no significant difference between them.The recurrence rate of lesions intra mucosa and submucosal superficial infiltration were 17.4%,21.4%,respectively,which statistical analysis showed no significant difference between them.During the follow-up period,total 71.4%patients recurred within the first year after ESD.[Conclusion]Lenth≥4 cm,size≥2/3 circumference,submucosal invasion are independent risk factors for positive margin after ESD.The recurrence rate of lesions intra mucosa and submucosal superficial infiltration shows no significant difference.