不同年龄早期食管癌及鳞状上皮内瘤变的临床特点分析  

Clinical characteristics of early esophageal cancer and squamous intraepithelial neoplasia in patients of different ages

作　　者：陈柯豫 黄艳齐 张玲利 Ke-Yu Chen;Yan-Qi Huang;Ling-Li Zhang(Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第一附属医院消化内科,河南省郑州市450000

出　　处：《世界华人消化杂志》2023年第6期238-243,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目,No.81802859.

摘　　要：背景近年来随着内镜技术的发展,内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)因其较低的并发症风险、较快的恢复速度等优点广泛应用于早期食管癌(early esophageal cancer,EEC)及鳞状上皮内瘤变(squamous intraepithelial neoplasia,SIN)的治疗.本研究重点评估了老年患者EEC及SIN的临床特点及行ESD治疗的安全性.目的分析不同年龄早期食管癌及鳞状上皮内瘤变的临床特点.方法收集自2019-01/2022-10在郑州大学第一附属医院行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的349例早期食管癌及鳞状上皮内瘤变(包括高级别上皮内瘤变及低级别上皮内瘤变)病例,按照手术时年龄分为老年组(≥65岁)与中青年组(<65岁),采用t检验或Mann-Whitney U检验,以及卡方检验或Fisher精确概率法,比较2组之间的一般临床资料(性别、吸烟情况、饮酒情况、高血压、糖尿病、冠心病、其他肿瘤史、腹部手术史及家族消化道肿瘤疾病史等)和病理资料(病变位置、病理类型、浸润深度、内镜分型、病变长径、是否同时存在多个病灶、是否合并慢性食管炎、胃息肉、萎缩性胃炎等),同时比较两组病例的术后相关指标(术后住院时间、术后出血、是否合并食管狭窄及切缘).结果老年组患者中患有高血压的人数较多(P=0.034),中青年组患者中吸烟比例更高(P=0.017),差异有统计学意义.从病变位置上来说,中青年组病变多位于胸下段,而老年组病变多位于胸中段(P=0.005),且老年组发现时病变较中青年组更严重(P=0.005),也更高比例的合并有胃息肉(P=0.026).而ESD术后并发症及住院时间等方面,老年组与中青年组无明显差异.结论老年早期食管癌及鳞状上皮内瘤变患者合并疾病更多、病变相对严重,好发于胸中段,可结合病变位置等方面的不同予以进行更为细致的内镜下观察和密切的随访,改善患者的预后.BACKGROUND In recent years,with the development of endoscopic technology,endoscopic submucosal dissection(ESD)has been widely used in the treatment of early esophageal cancer(EEC)and squamous intraepithelial neoplasia(SIN)because of its low risk of complications and faster recovery.This study focused on evaluating the clinical features of EEC and SIN in elderly patients and the safety of ESD treatment.AIM To analyze the clinical characteristics of EEC and SIN in patients of different ages.METHODS A total of 349 patients with EEC or SIN(including high-and low-grade intraepithelial neoplasia)treated by endoscopic submucosal dissection(ESD)at the First Affiliated Hospital of Zhengzhou University from January 2019 to October 2022 were included.According to the age at the time of surgery,the patients were divided into either an elderly group(≥65 years old)or a young and middle-aged group(<65 years old),and the general clinical data(gender,smoking status,alcohol consumption,hypertension,diabetes,coronary heart disease,history of other tumors,abdominal surgery history,family history of digestive tract tumor,etc.)and pathological data(lesion location,pathological type,depth of invasion,endoscopic classification,lesion length and diameter,presence of multiple lesions or not,combination with chronic esophagitis,gastric polyps,or atrophic gastritis or not,etc.)were compared between the two groups,and the postoperative related indicators(postoperative hospital stay,postoperative bleeding,esophageal stricture,and resection margin)of the two groups were compared.RESULTS The number of patients with hypertension was significantly higher in the elderly group(P=0.034),while the proportion of patients with smoking history was significantly higher in the middle-aged and young group(P=0.017).In terms of lesion location,the lesions in the young and middle-aged group were mostly located in the lower thoracic segment,while the lesions in the elderly group were mostly located in the middle thoracic segment(P=0.005);the lesions in the e

关 键 词：早期食管癌 鳞状上皮内瘤变 内镜下黏膜剥离术 年龄 

分 类 号：R735.1[医药卫生—肿瘤]