食管早期癌内镜下黏膜剥离术后发生食管狭窄的危险因素分析  

Risk factors of esophageal stenosis after endoscopic submucosal dissection of early esophageal carcinoma

作　　者：姬朝霞 孟倩倩 刘安祥[1] JI Zhaoxia;MENG Qianqian;LIU Anxiang(Endoscopic Diagnosis and Treatment Center,Anyang Tumor Hospital,Anyang 455000,China)

机构地区：[1]安阳市肿瘤医院内镜诊疗中心,河南安阳455000

出　　处：《肿瘤基础与临床》2023年第2期133-136,共4页journal of basic and clinical oncology

摘　　要：目的 分析食管早期癌内镜下黏膜剥离术(ESD)后发生食管狭窄的危险因素。方法 选取2020年1月至2021年1月在安阳市肿瘤医院接受ESD治疗的180例食管早期癌患者为研究对象,根据术后情况将其分为狭窄患者和非狭窄患者,收集患者临床病理资料(年龄、性别、手术时间、体重指数、病理学类型、病灶位置、病变位置环周直径、病灶纵向长径、组织浸润深度、术后创面>3/4食管周径、固有肌层损伤),并分析患者发生食管狭窄的危险因素。结果 180例食管早期癌患者有21例发生术后狭窄,发生率为11.67%。狭窄患者鳞癌占比76.19%(16/21)、病变位置环周直径(38.02±5.62)mm、病灶纵向长径(44.83±8.65)mm、组织浸润深度m_(3)+sm_(1)占比76.19%(16/21)、术后创面>3/4食管周径占比61.90%(13/21)、固有肌层损伤占比33.33%(7/21),均高于非狭窄患者的50.31%(80/159)、(27.34±5.37)mm、(31.65±7.29)mm、27.67%(44/159)、30.19%(48/159)、6.92%(11/159),差异均有统计学意义(χ^(2)=4.990,P=0.025;t=8.520,P<0.001;t=7.614,P<0.001;χ^(2)=19.650,P<0.001;χ^(2)=8.329,P=0.003;χ^(2)=14.389,P<0.001)。病理学类型(OR=1.425,95%CI:1.201~3.616,P=0.027)、病变位置环周直径(OR=2.063,95%CI:1.375~4.911,P<0.001)、病灶纵向长径(OR=1.958,95%CI:1.481~5.196,P=0.008)、组织浸润深度(OR=2.347,95%CI:1.826~5.845,P<0.001)、术后创面>3/4食管周径(OR=2.024,95%CI:1.425~6.844,P=0.001)、固有肌层损伤(OR=2.335,95%CI:1.640~5.951,P<0.001)为患者发生术后食管狭窄的独立危险因素。结论 食管早期癌患者实施ESD术后发生食管狭窄与病理学类型、病变位置环周直径、病灶纵向长径、组织浸润深度、术后创面>3/4食管周径、固有肌层损伤有关,临床可根据上述因素筛选高危患者。Objective To analyze the risk factors of esophageal stenosis after endoscopic submucosal dissection(ESD)of early esophageal carcinoma.Methods A total of 180 patients with early esophageal carcinoma received ESD treatment in Anyang Tumor Hospital from January,2020 to January,2021 were selected as research subjects,they were divided into stricture patients and non-stenosis patients according to the postoperative situation,and the clinical data of the patients were collected(age,gender,operation time,body mass index,pathological type,lesion location,lesion location circumferential diameter,longitudinal length of lesion,depth of tissue invasion,postoperative wound>3/4 esophageal circumferential diameter and muscular propria injury),the risk factors of esophageal stenosis were analyzed.Results Among the 180 patients with early esophageal carcinoma,21 patients developed postoperative esophageal stenosis,with an incidence rate of 11.67%.Squamous cell carcinoma accounted for 76.19%(16/21)of stenosis patients,the circumferential diameter of the lesion location(38.02±5.62)mm,the longitudinal length of the lesion(44.83±8.65)mm,the depth of tissue invasion m 3+sm 1 accounted for 76.19%(16/21),the postoperative wound>proportion of 3/4 esophageal circumference diameter accounted for 61.90%(13/21)and the proportion of muscular propria injury accounted for 33.33%(7/21),which were higher than 50.31%(80/159),(27.34±5.37)mm,(31.65±7.29)mm,27.67%(44/159),30.19%(48/159),6.92%(11/159)of non-stenosis patients,and the differences were statistically significant(χ^(2)=4.990,P=0.025;t=8.520,P<0.001;t=7.614,P<0.001;χ^(2)=19.650,P<0.001;χ^(2)=8.329,P=0.003;χ^(2)=14.389,P<0.001).Pathological type(OR=1.425,95%CI:1.201-3.616,P=0.027),circumferential diameter of lesion location(OR=2.063,95%CI:1.375-4.911,P<0.001),longitudinal length of lesion(OR=1.958,95%CI:1.481-5.196,P=0.008),tissue infiltration depth(OR=2.347,95%CI:1.826-5.845,P<0.001),postoperative wound>3/4 esophageal circumference(OR=2.024,95%CI:1.425-6.844,P=0.001)and muscular pro

关 键 词：食管早期癌 内镜下黏膜剥离术 食管狭窄 危险因素 

分 类 号：R735.1[医药卫生—肿瘤]