非治愈性ESD治疗对追加食管癌根治术后并发症的影响  

Effect of non-curative ESD on postoperative complications after additional esophagectomy

作　　者：卢荣鑫 刘锦源[1] 薛磊[1] 范骏[1] 骆金华[1] LU Rongxin;LIU Jinyuan;XUE Lei;FAN Jun;LUO Jinhua(Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院胸外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第11期1586-1589,1598,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：吴阶平医学基金课题(320.6750.19008)。

摘　　要：目的:探讨内镜下黏膜下剥离术(endoscopic submucosal dissection,ESD)对追加胸腹腔镜联合食管癌根治术后并发症的影响,并进一步研究二次手术合适的间隔时间。方法:收集2019年10月—2022年10月在南京医科大学第一附属医院行胸腹腔镜联合食管癌根治手术患者831例,其中52例在食管癌根治术前行ESD手术,其余779例未接受ESD手术,以倾向性评分进行1∶3匹配,将全部患者分为ESD+OP组(52例)和Non-ESD+OP组(149例),对比两组患者术后并发症发病率,研究ESD术后不同时间点行食管癌根治术的优劣。结果:ESD+OP组患者食管癌根治术后的并发症发生率高于Non-ESD+OP组(59.6%vs.33.6%,P=0.001),其中肺部感染(26.9%vs.10.7%,P=0.001)、吻合口瘘(13.5%vs.4.7%,P=0.033)发生率明显增加。与其余时间段相比,ESD术后2~4周追加食管癌根治术并发症发生率较低(38.1%vs.75.0%,P=0.033),手术较为安全。结论:非治愈性ESD治疗会增加食管癌根治术后并发症及手术风险;ESD术后2~4周追加食管癌根治术较为安全,可有效降低手术风险。Objective:To evaluate the effect of non-curative endoscopic submucosal dissection(ESD)on postoperative complications after additional thoraco-laparoscopic esophagectomy and to investigate the optimal interval between non-curative ESD and additional esophagectomy.Methods:A total of 831 patients with esophageal cancer who underwent thoraco-laparoscopic esophagectomy in our hospital between October 2019 and October 2022 were collected.Among them,52 patients underwent ESD prior to esophagectomy,while 779 patients did not.Propensity score matching(PSM)was performed at a 1∶3 ratio,dividing the patients into an ESD+OP group(52 cases)and a Non-ESD+OP group(149 cases).The incidence of postoperative complications was compared between the two groups,and the outcomes of esophagectomy performed at different time points after ESD were evaluated.Results:The incidence of postoperative complications was higher in the ESD+OP group than the Non-ESD+OP group(59.6%vs.33.6%,P=0.001),with significantly increased rates of pulmonary infection(26.9%vs.10.7%,P=0.001)and anastomotic leakage(13.5%vs.4.7%,P=0.033).The lowest complication rate(38.1%vs.75.0%,P=0.033)and the safest outcomes were observed when esophagectomy was performed 2 to 4 weeks after ESD.Conclusion:The non-curative ESD may increased the postoperative complications and the risk of esophagectomy.Performing esophagectomy 2 to 4 weeks after ESD is relatively safer and can effectively reduce surgical risk.

关 键 词：食管癌根治术 非治愈性ESD 术后并发症 时间间隔 

分 类 号：R735.1[医药卫生—肿瘤]