食管癌患者内镜黏膜下剥离术后复发的高危因素及其防护措施

High Risk Factors and Protective Measures for Recurrence after Endoscopic Submucosal Dissection in Patients with Esophageal Cancer

目的:探讨食管癌患者内镜黏膜下剥离术(ESD)后复发的高危因素及其防护措施。方法:回顾性选取2020年1月-2022年12月厦门市中医院收治的82例食管癌患者。收集所有患者一般资料。所有患者均行ESD治疗并开展1年随访。根据复发情况将其分为复发组与未复发组。分析分组情况。比较复发组与未复发组一般资料。分析影响食管癌患者ESD术后复发的因素。结果:82例患者共出现12例复发,复发率为14.63%(12/82),纳入复发组;未复发70例,纳入未复发组。复发组重度术中粘连、术后合并脉管瘤栓、病变直径≥3 cm、肿瘤浸润深度T_(1b)、病灶不完整切除、术后未参与化疗占比均高于未复发组,差异有统计学意义(P<0.05)。多因素分析显示,术中重度粘连、术后合并脉管瘤栓、病变直径≥3 cm、肿瘤浸润深度T_(1b)、病灶未完整切除、术后未参与化疗为影响食管癌患者ESD术后复发的高危因素(P<0.05)。结论:食管癌患者ESD术后复发与术中重度粘连、术后合并脉管瘤栓、病变直径≥3 cm、肿瘤浸润深度T_(1b)、病灶未完整切除、术后未参与化疗关系密切,还需高度重视,针对性开展干预措施,尽可能完善干预措施,减少术后复发风险。

Objective:To explore the high risk factors and protective measures for recurrence after endoscopic submucosal dissection(ESD)in patients with esophageal cancer.Method:A total of 82 patients with esophageal cancer admitted to Xiamen Traditional Chinese Medicine Hospital from January 2020 to December 2022.The general information of all patients was collected.All patients received ESD treatment and underwent 1-year follow-up.According to the recurrence situation,they was divided into recurrence group and non recurrence group.The grouping situation was analyzed.The general information between the recurrent group and the non recurrent group was compared.The factors that affect the recurrence of esophageal cancer patients after ESD surgery was analyzed.Result:Out of 82 patients,a total of 12 recurred,with a recurrence rate of 14.63%(12/82),and were included in the recurrence group;and 70 cases without recurrence were included in the non recurrence group.The proportion of severe intraoperative adhesions,postoperative complications of vascular tumor thrombus coindition,lesion diameter≥3 cm,tumor infiltration depth T_(1b),incomplete lesion resection,and no postoperative participation in chemotherapy in the recurrence group were all higher than those in the non recurrence group,and the differences were statistically significant(P<0.05).Multiple factors analysis showed that severe adhesion during surgery,postoperative complications of vascular tumor thrombus coindition,lesion diameter≥3 cm,tumor infiltration depth T_(1b),incomplete resection of the lesion,and failure to participate in chemotherapy after surgery were high-risk factors for ESD recurrence in esophageal cancer patients(P<0.05).Conclusion:The recurrence of esophageal cancer patients after ESD surgery is closely related to severe adhesion during surgery,postoperative complications of vascular tumor thrombus coindition,lesion diameter≥3 cm,tumor infiltration depth T_(1b),incomplete lesion resection,and failure to participate in chemotherapy after surgery.Therefore,it is necessary to attach great importance to targeted intervention measures,improve intervention measures as much as possible,and reduce the risk of postoperative recurrence.