大范围早期食管癌内镜黏膜下剥离术后发生难治性狭窄的危险因素分析  

Risk factors of refractory esophageal stenosis after large-scale endoscopic submucosal dissection for patients with early esophageal cancer

作　　者：唐健[1] 刘枫[1] 陈洁[1] 施新岗[1] 李兆申[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433

出　　处：《中华消化内镜杂志》2017年第6期385-388,共4页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（81670604）

摘　　要：目的探讨大范围早期食管癌内镜黏膜下剥离术（ESD）术后发生难治性狭窄的危险因素。方法2011年1月至2016年9月，因早期食管癌在长海医院消化内镜中心行ESD治疗，剥离范围≥3／4环周，术后发生狭窄的35例病例纳入回顾性分析，按狭窄的内镜下扩张次数分成难治性狭窄组（n=21）和非难治性狭窄组（n=14），组间对比分析使用t检验或Fisher确切概率法。结果2组在固有肌层损害（P=0．018）、黏膜剥离纵径长度（P=0．013）、肿瘤浸润深度（P=0．031）以及止血夹使用数量（P=0．031）方面差异有统计学意义，在既往放化疗史、肿瘤位置、内镜下分型、术后口服激素等方面未见统计学差异（P〉0．05）。结论对于早期食管癌行大范围ESD治疗者，肿瘤浸润深度超过M2、术中固有肌层损伤、黏膜剥离纵径≥50mm以及止血夹使用数量≥6个时术后可能易发生难治性狭窄。Objective To analyze the risk factors of refractory postoperative stenosis after largescale endoscopic submucosal dissection （ESD） for patients with early esophageal cancer. Methods The data of 35 postoperative stenosis patients previously treated by ESD （dissection ≥ 3/4 circumferential） for early esophageal cancer from January 2011 to September 2016 in Digestive Endoscopy Center, Changhai Hospital were reviewed. According to the number of endoscopic dilation, 35 patients were divided into two groups： refractory stenosis （≥6 endoscopic dilations, n= 21 ） and non-refractory stenosis （≤5 endoscopic dilations, n = 14）, comparison between the two groups was performed using t test or Fisher exact probability method. Results Muscle layer damage （ P = 0. 018 ）, longitudinal mucosal defect length （ P = 0. 013 ）, tumor infiltrating depth （P = 0. 031 ）, and the number of hemostatic clips （ P = 0. 031 ） were significantly different between the two groups. The history of chemotherapy and radiotherapy, the location of tumor, the macroscopic type, and the postoperative administration of oral prednisolone were not significant differences between the two groups （P 〉 0. 05 ）. Conclusion Refractory esophageal stenosis commonly occurs in patients undergoing large-scale ESD with tumor depth 〉 M2, muscle layer damage, longitudinal mucosal defect length ≥50 mm and the number of hemostatie clips ≥6.

关 键 词：食管狭窄 早期食管癌 内镜黏膜下剥离术 危险因素 

分 类 号：R735.1[医药卫生—肿瘤]