早期食管癌内镜黏膜下剥离术后食管狭窄的特征及影响因素探讨  

Characteristics and influencing factors of esophageal stenosis after endoscopic submucosal dissection for early esophageal carcinoma

作　　者：高勇 柏健鹰 林辉 樊超强 李建军 彭学 杨歆 于劲 聂绪彪 赵海燕 Gao Yong;Bai Jianying;Lin Hui;Fan Chaoqiang;Li Jianjun;Peng Xue;Yang Xin;Yu Jin;Nie Xubiao;Zhao Haiyan(Department of Gastroenterology,The Second Affiliated Hospital,Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院消化内科,重庆400037

出　　处：《中华消化内镜杂志》2021年第9期723-727,共5页Chinese Journal of Digestive Endoscopy

基　　金：陆军军医大学第二附属医院临床重大创新特色技术项目(2018JSLC011)。

摘　　要：目的探讨早期食管癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后发生食管狭窄的特征及可能的影响因素。方法以2011年1月—2018年12月在陆军军医大学第二附属医院消化内镜中心接受ESD治疗的患者为研究对象,通过病历、随访获取患者的病例资料,采用单因素分析和Cox回归分析发生食管狭窄的相关因素。结果接受ESD治疗的654例患者中79例(12.1%)出现术后食管狭窄,从接受ESD到发生狭窄的中位时间为27(17,43)d。病变形态和病变环周比例是狭窄发生的独立相关因素,其中Ⅱa型病变狭窄发生率是Ⅱc型病变的6.601倍(95%CI:1.518~28.709,P=0.012),环周比例75%~<100%和100%者狭窄发生率分别是环周比例<75%者的17.408倍(95%CI:8.009~37.839,P<0.001)和52.439倍(95%CI:23.905~115.029,P<0.001)。79例狭窄患者中27例为严重狭窄,病变环周比例是严重狭窄发生的独立相关因素,环周比例75%~<100%和100%者严重狭窄发生率分别是环周比例<75%者的7.775倍(95%CI:1.977~30.577,P=0.003)和70.062倍(95%CI:19.879~246.926,P<0.001)。结论早期食管癌病变形态和病变环周比例是ESD术后狭窄发生的独立相关因素,病变环周比例是严重狭窄发生的独立相关因素。Objective To investigate the characteristics and influencing factors of esophageal stenosis after endoscopic submucosal dissection(ESD)for early esophageal carcinoma.Methods Patients who underwent ESD in the Digestive Endoscopy Center of the Second Affiliated Hospital of Army Medical University from January 2011 to December 2018 were included.The data were obtained from medical records and follow-up.The influencing factors of stenosis were determined by single factor and Cox regression analysis.Results A total of 654 patients underwent ESD and 79(12.1%)of them developed postoperative esophageal stenosis.The median time of stenosis development was 27(17,43)days.The morphology and lesion circumferential proportion were independent factors for the occurrence of stenosis after ESD.The stenosis incidence of typeⅡa was 6.601 times(95%CI:1.518-28.709,P=0.012)compared with that of typeⅡc.The incidence of stenosis in lesions with 75%-<100%and 100%circumference was 17.408 times(95%CI:8.009-37.839,P<0.001)and 52.439 times(95%CI:23.905-115.029,P<0.001)respectively compared with that of patients<75%.Among the 79 patients,27 had severe stenosis,and the lesion circumferential proportion was an independent factor for stenosis.Compared with the group of lesion circumferential proportion of less than 75%,the incidences of stenosis of lesion circumferential proportion of 75%-<100%and 100%were 7.775(95%CI:1.977-30.577,P=0.003)and 70.062(95%CI:19.879-246.926,P<0.001)times respectively.Conclusion The morphology and lesion circumferential proportion are two independent factors for the occurrence of esophageal stenosis after ESD.Additionally,lesion circumferential proportion is an independent factor for the occurrence of severe esophageal stenosis after ESD.

关 键 词：食管狭窄 食管肿瘤 危险因素 内镜黏膜下剥离术 

分 类 号：R735.1[医药卫生—肿瘤]