内镜黏膜下隧道法剥离术治疗食管黏膜内癌及黏膜下癌的疗效及手术时间影响因素  

Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: ef?cacy and factors in?uencing operative time

作　　者：王玉欣 朱季军 刘云云 王艳 刘伟 蔡奉娟 王晓燕 Wang Yuxin;Zhu Jijun;Liu Yunyun;Wang Yan;Liu Wei;Cai Fengjuan;Wang Xiaoyan(Department of Gastroenterology,Suqian No.1 People′s Hospital,Suqian 223800,China)

机构地区：[1]宿迁市第一人民医院消化科

出　　处：《中华临床医师杂志（电子版）》2019年第9期675-679,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨内镜黏膜下隧道法剥离术(ESTD)治疗食管黏膜内癌及黏膜下癌疗效及手术时间影响因素。方法回顾性分析宿迁市第一人民医院2015年11月至2018年12月收治食管黏膜内癌及黏膜下癌133例患者的临床资料,其中80例采用内镜黏膜下剥离术(ESD)治疗为A组,53例采用ESTD治疗为B组,比较2组切除效果、手术相关临床指标及手术相关并发症发生率;采用Logistic回归模型分析影响手术时间的因素。结果 2组整块切除率和根治性切除率比较差异无统计学意义(P> 0.05);B组总手术时间和黏膜下剥离时间均少于A组(P <0.05)、剥离速度大于A组(P <0.05);2组术后出血、术后发热及术后胸痛发生率比较,差异无统计学意义(P> 0.05);B组术中肌层损伤率和术中出血发生率均低于A组(P <0.05)。Logistic回归模型分析结果显示,应用ESTD和病灶面积<9 cm2是手术时间的独立影响因素(P <0.05)。结论 ESTD治疗食管黏膜内癌及黏膜下癌可有效缩短总手术时间和黏膜下剥离时间,提高黏膜剥离速度,降低术中肌层损伤率和术中出血发生风险,且总体切除效果与ESD相当;手术时间与手术方式、病灶面积密切相关。Objective To evaluate the efficacy of endoscopic submucosal tunnel dissection(ESTD) in the treatment of esophageal intramucosal and submucosal cancer and explore the factors influencing operation time. Methods A total of 133 patients with esophageal intramucosal and submucosal carcinomas treated at our hospital from November 2015 to December 2018 were retrospectively analyzed. Among them, 80 patients were treated by endoscopic submucosal dissection(ESD;group A) and 53 patients were treated by ESTD(group B). Logistic regression analysis was used to identify the factors influencing operation time. Results There was no significant difference between the two groups in the rates of total excision and radical excision(P > 0.05);the total operation time and the time of submucosal dissection in group B were significantly less than those of group A(P < 0.05). The speed of submucosal dissection in group B was significantly higher than that in group A(P < 0.05). There was no significant difference in the rates of bleeding, fever, and chest pain after operation between the two groups(P > 0.05). The rates of muscle layer injury and bleeding during operation in group B were significantly lower than those of group A(P < 0.05). Logistic regression analysis showed that ESTD application and lesion area < 9 cm2 were independent influencing factors of operation time(P < 0.05). Conclusion ESTD for esophageal intramucosal and submucosal carcinomas can effectively shorten total operation time and submucosal dissection time, improve the speed of mucosal dissection, and reduce the incidence of intraoperative myometrial injury and intraoperative bleeding, with a similar overall resection effect to ESD. Operation time is closely related to the type of endoscopy and the area of lesion.

关 键 词：内镜黏膜下隧道法剥离术 食管肿瘤 黏膜内癌 黏膜下癌 手术时间 

分 类 号：R73[医药卫生—肿瘤]