早期食管癌及癌前病变内镜黏膜下剥离术操作困难的影响因素分析

Influencing factors analysis of difficulty in endoscopic submucosal dissection for early eso-phageal cancer and precancerous lesions

目的探讨早期食管癌及癌前病变内镜黏膜下剥离术(ESD)操作困难的影响因素.方法采用回顾性病例对照研究方法.收集2011年12月至2021年12月新乡市中心医院收治的331例早期食管癌及癌前病变患者的临床病理资料;男229例,女102例;年龄为(72.6±2.7)岁.患者均行ESD治疗.正态分布的计量资料采用(x)±s表示,组间比较采用t检验.计数资料以绝对数表示,组间比较采用x2检验.单因素分析根据资料类型选择对应的统计学方法.多因素分析采用Logistic逐步回归模型.结果(1)ESD手术情况.331例患者手术时间为(67±8)min,整块切除327例、分块切除4例.331例患者发生不良事件:出血1例、纵隔气肿2例、食管狭窄2例、食管穿孔3例,以上患者均采用保守治疗,无需手术.331例患者肿瘤浸润深度:上皮层109例、黏膜固有层155例、黏膜肌层9例、黏膜下层(<0.2 mm)12例、黏膜下层(≥0.2 mm)42例.331例患者中,鳞状细胞癌302例,腺癌29例.331例患者中,57例为ESD操作困难.(2)早期食管癌及癌前病变ESD操作困难的影响因素分析.多因素分析结果显示:食管左壁肿瘤、纵向肿瘤长径>30 mm和肿瘤周长与食管周长比>1/2是早期食管癌及癌前病变ESD操作困难的独立危险因素(优势比=3.903,6.699,5.387,95%可信区间为1.423~10.702,1.222~36.735,1.492~19.468,P<0.05).结论食管左壁肿瘤、纵向肿瘤长径>30 mm和肿瘤周长与食管周长比>1/2是早期食管癌及癌前病变ESD操作困难的独立危险因素.

Objective To investigate the influencing factors associated with the difficulty in endoscopic submucosal dissection(ESD)for early esophageal cancer and precancerous lesions.Methods The retrospective case-control study was conducted.The clinicopathological data of 331 patients with early esophageal cancer and precancerous lesions who were admitted to Xinxiang Central Hospital from December 2011 to December 2021 were collected.There were 229 males and 102 females,aged(72.6±2.7)years.All patients underwent ESD.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were represented as absolute numbers,and comparison between groups was analyzed using the chi-square test.The univariate analysis was performed using statistical methods appropriate to the data type.Multivariate analysis was conducted using the Logistic stepwise regre-ssion model.Results(1)Surgical situations of ESD.The operation time of 331 patients was(67±8)minutes.There were 327 patients with en bloc resection,and 4 patients with piecemeal resection.Of the 331 patients,adverse events included bleeding in 1 case,pneumomediastinum in 2 cases,esophageal stenosis in 2 cases,and esophageal perforation in 3 cases.All of these adverse events were treated conservatively without surgical intervention.Of the 331 patients,the depth of tumor invasion was epithelial layer in 109 cases,lamina propria in 155 cases,muscularis mucosa in 9 cases,submucosal layer(<0.2 mm)in 12 cases,and submucosal layer(≥0.2 mm)in 42 cases.Of the 331 pati-ents,there were squamous cell carcinoma in 302 cases and adenocarcinoma in 29 cases.Of the 331 pati-ents,57 cases had difficulties in ESD.(2)Analysis of Influencing factors associated with difficulty in ESD for early esophageal cancer and precancerous lesions.Results of multivariate analysis showed that esophageal cancer located in the left wall,longitudinal tumor diameter>30 mm,and tumor circumference exceeding half of the esophageal circumference were independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions(odds ratio=3.903,6.699,5.387,95%confidence interval as 1.423-10.702,1.222-36.735,1.492-19.468,P<0.05).Conclusion Esophageal cancer located in the left wall,tumor size greater than 30 mm and tumor circumference exceeding half of the esophageal circumference are independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions.