内镜治疗不同大小的食管早癌和癌前病变的临床效果分析

Clinical effect analysis of endoscopic treatment of early esophageal cancer and precancerous lesions of different sizes

摘要:

目的 探讨内镜下黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）治疗不同大小食管早癌及癌前病变的临床效果。方法 回顾性分析579例接受EMR与ESD治疗的食管早癌及癌前病变患者的临床资料，根据病灶大小，分为大病灶组（n = 277）和小病灶组（n = 302），分析EMR及ESD治疗不同大小病灶的效果和并发症情况。结果 小病灶组中，EMR组病灶完整切除率为93.2%，治愈性切除率为89.0%，与ESD组病灶的完整切除率92.6%和治愈性切除率90.4%比较，差异均无统计学意义（P > 0.05）；EMR组与ESD组的出血率和复发率比较，差异均无统计学意义（P > 0.05）。大病灶组中，EMR组病灶完整切除率为84.2%，治愈性切除率为84.2%，与ESD组病灶的完整切除率87.9%和治愈性切除率85.4%比较，差异均无统计学意义（P > 0.05）；EMR组与ESD组的出血率和复发率比较，差异均无统计学意义（P > 0.05）。多因素Logistic回归分析结果显示：食管上段（OR＾ = 5.098，95%CI：1.614～16.105，P = 0.006）是内镜治疗术后狭窄的危险因素；纵轴长度 < 5 cm（OR＾ = 0.164，95%CI：0.064～0.420，P = 0.000）和环周 ≤ 1/2（OR＾ = 0.302，95%CI：0.124～0.734，P = 0.008）是内镜治疗术后狭窄的保护因素。结论 EMR及ESD均是食管早癌及癌前病变有效且安全的治疗方式。病变位于食管上段、纵轴长度 ≥ 5 cm及环周 > 1/2是内镜治疗术后狭窄的危险因素。

Abstract:

Objective To evaluate the clinical value of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in early esophageal cancer and precancerous lesions of different sizes.Methods Retrospectively analyzed 579 cases of early esophageal cancer and precancerous lesions which received ESD and EMR. According to the size of lesions, the cases were divided into large-lesion group (n = 277) and small-lesion group (n = 302). Then compared the efficacy and complications of EMR and ESD in different sizes lesions.Results In small-lesion group: the complete resection rate of EMR was 93.2%, the curative resection rate of EMR was 89.0%, and the complete resection rate of ESD was 92.6%, the curative resection rate of ESD was 90.4%. Both of them had not statistically significant (P > 0.05). They were not statistically significant between EMR and ESD in bleeding and recurrence rates (P > 0.05). In large-lesion group: the complete resection rate of EMR was 84.2%, the curative resection rate of EMR was 84.2%, and the complete resection rate of ESD was 87.9%, the curative resection rate of ESD was 85.4%, which had not statistically significant (P > 0.05). The bleeding and recurrence rates in EMR were not statistically significant compared with ESD (P > 0.05). The results of multivariate Logistic regression analysis showed that the upper esophageal segment (OR＾ = 5.098, 95%CI: 1.614 ~ 16.105, P = 0.006) was risk factors for endoscopic treatment of postoperative stenosis; longitudinal axis length < 5 cm (OR＾ = 0.164, 95%CI: 0.064 ~ 0.420, P = 0.000) and circumferential ≤ 1/2 (OR＾ = 0.302, 95%CI: 0.124 ~ 0.734, P = 0.008) were protective factors for endoscopic treatment of postoperative stenosis.Conclusion Both EMR and ESD are effective and safe treatments for early esophageal cancer and precancerous lesions. Lesions located in the upper esophagus, ≥ 5 cm in the longitudinal axis length, and circumferential > 1/2 are risk factors for postoperative stenosis for endoscopic treatment.