超声内镜下内镜黏膜剥离术在乙型肝炎肝硬化患者食管良性肿瘤中的可行性研究  

Feasibility of endoscopic submucosal dissection of benign esophageal tumors in patients with hepatitis B virus-related cirrhosis

作　　者：陈衍磊 蔡永国 CHEN Yan-lei;CAI Yong-guo(Department of Gastroenterology,the 970th Hospital of Joint Logistics Support Force,Chinese People’s Liberation Army,Yantai 264000,China)

机构地区：[1]中国人民解放军联勤保障部队第九七〇医院消化内科,山东烟台264000

出　　处：《肝脏》2021年第9期984-986,共3页Chinese Hepatology

基　　金：2015年山东省医药卫生科技发展计划项目(2015WS0131)。

摘　　要：目的分析超声内镜下内镜黏膜剥离术(ESD)治疗乙肝肝硬化患者食管良性肿瘤的可行性。方法回顾2010年1月至2020年6月医院病历管理系统,纳入经ESD治疗的食管良性肿瘤患者174例,男性92例,女性82例,年龄(53.2±10.5)岁;其中伴有乙肝肝硬化患者34例(肝硬化组),不伴有乙肝肝硬化患者140例(非肝硬化组)。计量资料采用t检验或Kruskal-Wallis H检验,计数资料采用卡方检验。结果肝硬化组、非肝硬化组Child-Pugh评分分别为7(5,12)分、0(0,0)分,比较差异具有统计学意义(P<0.05),肝硬化组血小板计数[152(110,318)×10^(9)/L]明显低于非肝硬化组[245(142,330)×10^(9)/L,P<0.05];而肝硬化组INR[1.2(1.0,1.8)]明显高于非肝硬化组[1.0(0.9,1.3),P<0.05],另外两组患者年龄、性别、WBC、ALT、AST、总胆红素及白蛋白差异无统计学意义(P>0.05)。两组食管良性肿瘤直径、食管平滑肌瘤、肿瘤位置、ESD手术时间及肿瘤完整切除例数等比较差异无统计学意义(P>0.05);而肝硬化组、非肝硬化组ESD术后出血分别为6例(17.6%)、5例(3.6%),比较差异具有统计学意义(P<0.05),其中肝硬化组患者术后出血病例中有5例伴有食管静脉曲张。两组患者均未发生与ESD相关的食管穿孔或死亡病例。结论ESD治疗乙肝肝硬化食管良性肿瘤,特别是无严重肝硬化并发症患者是安全有效的。Objective To analyze the feasibility of endoscopic submucosal dissection(ESD)of benign esophageal tumors in patients with hepatitis B virus-related cirrhosis.Methods The hospital medical record management system between January 2010 and June 2020 was reviewed.One hundred and seventy-four patients of benign esophageal tumors treated with ESD were included,with an average age of(53.2±10.5).The numbers of male and female were 92 and 82,respectively.Thirty-four patients with hepatitis B virus-related cirrhosis were selected as the cirrhosis group,and 140 patients without hepatitis B virus-related cirrhosis were selected as the non-cirrhosis group.The differences of measurement data were analyzed through the t-test or Kruskal-Wallis H test,and the differences of enumeration data were analyzed through the chi-square test.Results The Child-Pugh score of cirrhosis group and non-cirrhosis group were 7(5,12)and 0(0,0),respectively,the difference was statistically significant(P<0.05).The platelet count of cirrhosis group[152(110,318)×10^(9)/L]was significantly lower than that of non-cirrhosis group[245(142,330)×10^(9)/L,P<0.05],while international normalized ratio(INR)of cirrhosis group[1.2(1.0,1.8)]was significantly higher than that of non-cirrhosis group[1.0(0.9,1.3),P<0.05].In addition,there was no significant difference in age,sex,white blood cell(WBC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin and albumin between the two groups.There was no significant difference in the diameter of esophageal benign tumor,esophageal leiomyoma,tumor location,ESD operation time and the number of complete tumor resection between the two groups.But there were 6(17.6%)and 5(3.6%)cases had postoperative bleeding in liver cirrhosis group and non-cirrhosis group,respectively,and the difference was statistically significant(P<0.05).Five cases of postoperative bleeding in cirrhosis group were combined with esophageal varices.Esophageal perforation or death related to ESD was not occurred in both groups.Concl

关 键 词：超声内镜下内镜黏膜剥离术 乙肝肝硬化 食管良性肿瘤 

分 类 号：R73[医药卫生—肿瘤]