食管早期肿瘤及癌前病变患者内镜黏膜下剥离术后并发吞咽困难的相关因素分析  

Analysis of factors associated with the occurrence of dysphagia after endoscopic submucosal dissection in patients with early esophageal cancer or precancerous lesions

作　　者：吕美慧 王美峰[1] 张国新[1] 林琳[1] 姜柳琴[1] Lyu Meihui;Wang Meifeng;Zhang Guoxin;Lin Lin;Jiang Liuqin(Department of Gastroenterology,the First Afiliated 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消化内科,南京210029

出　　处：《中华消化杂志》2024年第11期751-756,共6页Chinese Journal of Digestion

摘　　要：目的:分析食管早期肿瘤及癌前病变患者行内镜黏膜下剥离术(ESD)后并发吞咽困难的相关影响因素,并探索其临床预测价值。方法:纳入2020年3月1日至2021年3月31日确诊食管早期肿瘤及癌前病变并拟行ESD治疗且术前未发生吞咽困难的患者35例。ESD术后随访2年,根据2年内术后是否并发吞咽困难分为无吞咽困难组(22例)和吞咽困难组(13例),分析两组患者的人口学特征如性别、年龄,ESD相关资料如食管环周切除范围,高分辨率食管测压参数如远端收缩积分(DCI)、食管各段蠕动波波幅,以及精神心理状态如焦虑自评量表(SAS)评分等。采用多因素logistic回归分析ESD术后并发吞咽困难的独立影响因素并绘制独立危险因素的受试者操作特征曲线(ROC)评估其诊断效能。结果:多因素logistic回归分析显示,食管环周切除范围[OR=23.881,95%置信区间(95%CI)4.073~140.022]、SAS评分(OR=1.157,95%CI 1.029~1.300)、DCI平均值(OR=0.864,95%CI 0.750~0.995)和DCI最高值(OR=0.914,95%CI 0.837~0.998)均是ESD术后并发吞咽困难的独立影响因素(均P<0.05)。ROC分析显示,食管环周切除范围预测ESD术后并发吞咽困难的曲线下面积为0.895(95%CI 0.788~0.987,P<0.001),最佳截断值为72.50;SAS评分的曲线下面积为0.811(95%CI 0.660~0.962,P=0.001),最佳截断值为34.38。结论:远端食管压力降低和(或)收缩无力均可能参与了食管ESD术后吞咽困难的发生。当食管环周切除范围>管腔周径的72.5%或SAS评分>34分时,ESD术后吞咽困难的发生率更高。Objective:To analyze the factors associated with the occurrence of dysphagia after endoscopic submucosal dissection(ESD)treatment in patients with early esophageal cancer or precancerous lesions,and to explore their clinical predictive value.Methods:From March 1,2020 to March 31,2021,35 patients diagnosed with early esophageal cancer or precancerous lesions without dysphagia before ESD treatment were recruited.All the patients were followed up for 2 years after ESD,and were divided into the non-dysphagia group(22 cases)and dysphagia group(13 cases)according to the occurrence of postoperative dysphagia.The demographic characteristics(such as gender and age),ESD-related data(such as the range of circumferential resection),the parameters of high resolution esophageal manometry such as distal contraction integral(DCI),the amplitude of peristaltic waves in various esophageal segments,and the psychological states such as self-rating anxiety scale(SAS)scores of the 2 groups were analyzed.Multivariate logistic regression was used to analyze the independent influencing factors for the occurrence of dysphagia after ESD and receiver operating characteristic curve(ROC)of the independent risk factors was plotted to assess the diagnostic efficacy.Results:The result of multivariate logistic regression analysis showed that the range of circumferential resection(OR=23.881,95%confidence interval(95%CI)4.073 to 140.022),the SAS score(OR=1.157,95%CI 1.029 to 1.300),the mean value of DCI(OR=0.864,95%CI 0.750 to 0.995)and the maximum value of DCI(OR=0.914,95%CI 0.837 to 0.998)were independent influencing factors for postoperative dysphagia(all P<0.05).The result of ROC analysis showed that the area under the curve for the range of circumferential resection predicting dysphagia after ESD was 0.895(95%CI 0.788 to 0.987,P<0.001),with an optimal cut-off value of 72.50,and the area under the curve for SAS score was 0.811(95%CI 0.660 to 0.962,P=0.001),with an optimal cut-off value of 34.38.Conclusions:Reduced distal esophageal pressure,and(

关 键 词：吞咽困难 食管癌前病变 高分辨率食管测压 精神心理因素 环周切除范围 

分 类 号：R735.1[医药卫生—肿瘤]