早期食管癌及癌前病变内镜黏膜下剥离术后标本切缘阳性的危险因素分析  

Risk factors for positive resection margins after endoscopic submucosal dissection of early esophageal squamous carcinomas and precancerous lesions

作　　者：彭春艳[1] 吴龙云[1] 吕瑛[1] 张晓琦[1] 张以洋[1] 徐桂芳[1] 凌亭生[1] 王雷[1] 沈珊珊[1] 邹晓平[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化科,南京210008

出　　处：《中华消化内镜杂志》2016年第7期451-457,共7页Chinese Journal of Digestive Endoscopy

基　　金：基金项目：国家青年自然科学基金资助项目（81201908）;南京市医学科技发展项目（YKK14061）

摘　　要：目的探讨早期食管癌及癌前病变内镜黏膜下剥离术（ESD）术后标本出现切缘阳性的危险因素。方法对315例ESD治疗的早期食管鳞癌及癌前病变病例进行回顾性分析，汇总ESD术后标本切缘病理特征及切缘阳性患者随访结果，采用单因素和多因素的分析方法明确ESD术后标本切缘阳性的危险因素。结果315例病例中，切缘阴性290例、阳性25例，切缘阳性者包括单纯侧切缘阳性13例、单纯基底切缘阳性8例、基底和侧切缘均阳性4例。多因素分析显示：病变浸润深度（SM层浸润，P=0．048）是早期食管鳞癌及癌前病变ESD术后标本基底切缘阳性的独立危险因素；病变累及管周范围（≥3／4管周，P=0．014）、病变浸润深度（M3以深，P=0．007）是早期食管鳞癌及癌前病变ESD术后标本侧切缘阳性的独立危险因素。结论早期食管癌及癌前病变的病灶大小及浸润深度与ESD术后标本是否发生切缘阳性有直接关系，术前充分评估病灶范围及深度是避免ESD术后病灶残留及复发的关键。Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection （ESD） of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD.The pathological features of all resection margins in the specimen and the follow-up outcome of the patients with positive resection margin were evaluated. Univariate and multi- variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions, there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion （submucosal layer invasion, P = 0. 048） was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension （ ≥ 3/4,P = 0. 014） and the depth of invasion（ exceeding mnscularis mueosa, P = 0. 007） were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.

关 键 词：内镜黏膜下剥离术 早期食管癌 癌前病变 切缘阳性 

分 类 号：R735.1[医药卫生—肿瘤]