食管病变经内镜黏膜下剥离术治疗后食管狭窄的发生情况及其相关影响因素分析

Analysis of the occurrence of esophageal stenosis after endoscopic submucosal dissection and its related influencing factors

摘要:

目的 分析食管病变经内镜黏膜下剥离术（ESD）治疗后食管狭窄的发生情况及其相关影响因素。方法 回顾性分析150例2015年11月－2020年12月该院收治的食管病变患者的临床资料，所有患者均进行ESD治疗，根据患者经ESD治疗后是否出现食管狭窄，将其分为狭窄组（26例）和未狭窄组（124例）。统计食管病变患者经ESD治疗后食管狭窄的发生情况，分析狭窄组和未狭窄组一般资料，并采用多因素Logistic回归分析法，分析食管病变患者经ESD治疗后发生食管狭窄的危险因素。结果 150例食管病变患者经ESD治疗后，发生食管狭窄26例，食管狭窄发生率为17.33%。狭窄组病变长度 ≥ 5 cm、固有肌层损伤、创面环周黏膜缺损程度 ≥ 7/8周、无预防狭窄措施、病变浸润深度为m3～sm1的患者占比分别为23.08%、30.77%、23.08%、73.08%和46.15%，均高于未狭窄组的7.26%、6.45%、5.64%、39.52%和7.26%（P < 0.05）。多因素Logistic回归分析结果显示，病变长度 ≥ 5 cm、固有肌层损伤、创面环周黏膜缺损程度 ≥ 7/8周、无预防狭窄措施、病变浸润深度为m3～sm1均是食管病变经ESD治疗后发生食管狭窄的独立危险因素（OR＾ = 3.077、3.370、3.445、2.762和2.659，P < 0.05）。结论 食管病变患者经ESD治疗后，食管狭窄发生率较高，发生食管狭窄的危险因素包括：病变长度 ≥ 5 cm，固有肌层损伤，创面环周黏膜缺损程度 ≥ 7/8周，无预防狭窄措施，病变浸润深度为m3～sm1等，临床可据此对食管病变患者的治疗及护理方案进行调整，以降低食管病变经ESD治疗后发生食管狭窄的风险。

Abstract:

Objective To analyze the occurrence and related influencing factors of esophageal stenosis in patients with esophageal lesions treated by endoscopic submucosal dissection (ESD).Methods Clinical data of 150 patients with esophageal lesions from November 2015 to December 2020 were retrospectively collected, all these patients underwent ESD, and the patients were divided into the stenosis group (26 cases) and the non-stenosis group (124 cases) according to whether they had esophageal stenosis after ESD. The occurrence of esophageal stenosis in patients with esophageal lesions treated by ESD was statistically analyzed, the general data of the stenosis group and the non-stenosis group were analyzed, and the risk factors of esophageal stenosis in patients with esophageal lesions treated by ESD were analyzed by multivariate Logistic regression analysis.Results 150 patients with esophageal lesions, 26 patients had esophageal stenosis after ESD, and the incidence of esophageal stenosis was 17.33%. The proportion of patients with lesion length ≥ 5 cm, intrinsic muscularis injury, wound circumferential mucosal defect ≥ seven-eights a circle, no measures to prevent stenosis and lesion infiltration depth of m3~sm1 in the stenosis group were 23.08%, 30.77%, 23.08%, 73.08%, 46.15% respectively, which were higher than 7.26%, 6.45%, 5.64%, 39.52%, 7.26% in the non-stenosis group (P < 0.05). Multivariate Logistic regression analysis show that lesion length ≥ 5 cm, intrinsic muscularis injury, wound circumferential mucosal defect ≥ seven-eights a circle, no measures to prevent stenosis and lesion infiltration depth of m3 ~ sm1 were independent risk factors for esophageal stenosis after ESD (OR＾ = 3.077; 3.370; 3.445; 2.762; 2.659, P < 0.05).Conclusion The incidence of esophageal stenosis in patients with esophageal lesions after ESD was high, and the risk factors of esophageal stenosis include lesion length ≥ 5 cm, intrinsic muscularis injury, wound circumferential mucosal defect ≥ seven-eights a circle, no measures to prevent stenosis and lesion infiltration depth of m3~sm1, et al. The clinical treatment and nursing plan of patients with esophageal lesions could be adjusted to reduce the risk of esophageal stenosis after ESD.