内镜黏膜下剥离术治疗食管环周早癌的临床分析（附38例报告）

Clinical analysis of endoscopic submucosal dissection treating early circumferential esophageal cancer (38 cases)

摘要:

目的 评价内镜黏膜下剥离术（ESD）治疗食管环周早癌的有效性、安全性和术后并发症情况。方法 回顾性分析郑州大学第一附属医院2018年－2020年38例行ESD治疗食管环周早癌的患者的临床资料，按术后食管狭窄的治疗方式分为术后直接置入支架组（n = 6）、未置入支架组（n = 26）和因ESD术后狭窄定期扩张后再置入支架组（n = 6）。结果 环周缺损长度平均4.5 cm；术中穿孔1例、术后迟发性出血1例、术后发热5例、术后食管狭窄行扩张治疗中发生穿孔1例，术后穿孔的1例并发食管纵隔瘘，经保守治疗后好转。食管狭窄为其最常见的并发症，发生率为100.0%。患者平均住院8.6 d，平均手术时间186.8 min。ESD术后直接置入支架组的术后首次扩张时间及平均扩张间隔明显长于未置入支架组，因ESD术后狭窄定期扩张后再置入支架组置入后平均扩张间隔明显长于置入支架前，组间和组内比较，差异均有统计学意义（P > 0.05）。平均随访时间507.0 d，患者无复发。结论 ESD治疗食管环周早癌是安全、有效的，虽然术后食管狭窄不可避免，但行食管扩张术或预防性支架置入/中途支架置入均能明显缓解狭窄进程，具有较良好的临床应用价值。

Abstract:

Objective To evaluate the efficacy, safety and postoperative complications of the endoscopic submucosal dissection (ESD) treating early circumferential esophageal cancer.Methods A retrospective analysis was performed on 38 patients who underwent ESD treating early circumferential esophageal cancer from 2018 to 2020. According to the postoperative treatment of esophageal stricture, the patients were divided into three groups: direct stent implantation group (n = 6), non-stent implantation group (n = 26), and midway stent implantation group after regular expansion of esophageal stricture after ESD (n = 6).Results The average length of circumferential defect was 4.5 cm. There were 1 patient with intraoperative perforation, 1 patient with delayed postoperative hemorrhage, 5 with postoperative fever, 1 with perforation in postoperative dilation treatment for esophageal stricture, coupled with the improvement of the complications of esophageal mediastinal fistula after conservative treatment. Esophageal stenosis is the most common complication, with an incidence rate of 100.0%. The average length of hospital stay was 8.6 d, with the average length of surgery as 186.8 min. The first postoperative expansion time and mean expansion interval of the direct stent implantation group were significantly longer than those of the non-stent implantation group, and the mean expansion interval of the midway stent implantation group after regular expansion of esophageal stricture after ESD, similarly, was also significantly longer than that of the pre-stent implantation group, with statistically significant differences. Thirty-eight patients were followed up for 507.0 d on average, without recurrence.Conclusion ESD treating early circumferential esophageal cancer is technically safe and effective. Although postoperative esophageal stenosis is inevitable, preventive stent placement or remedial stent placement can alleviate the stenosis process significantly, showing favorable clinical application value.