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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (09) : 675 -679. doi: 10.3877/cma.j.issn.1674-0785.2019.09.007

所属专题： 文献；

临床研究

内镜黏膜下隧道法剥离术治疗食管黏膜内癌及黏膜下癌的疗效及手术时间影响因素
王玉欣1, 朱季军1, 刘云云1, 王艳1, 刘伟1, 蔡奉娟1, 王晓燕1,†()   
  1. 1. 223800　宿迁市第一人民医院消化科
  • 收稿日期:2019-03-18 出版日期:2019-05-01
  • 通信作者: 王晓燕

Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors influencing operative time

Yuxin Wang1, Jijun Zhu1, Yunyun Liu1, Yan Wang1, Wei Liu1, Fengjuan Cai1, Xiaoyan Wang1,†()   

  1. 1. Department of Gastroenterology, Suqian No. 1 People′s Hospital, Suqian 223800, China
  • Received:2019-03-18 Published:2019-05-01
  • Corresponding author: Xiaoyan Wang
  • About author:
    Corresponding author: Wang Xiaoyan, Email:
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引用本文：

王玉欣, 朱季军, 刘云云, 王艳, 刘伟, 蔡奉娟, 王晓燕. 内镜黏膜下隧道法剥离术治疗食管黏膜内癌及黏膜下癌的疗效及手术时间影响因素[J]. 中华临床医师杂志(电子版), 2019, 13(09): 675-679.

Yuxin Wang, Jijun Zhu, Yunyun Liu, Yan Wang, Wei Liu, Fengjuan Cai, Xiaoyan Wang. Endoscopic submucosal dissection for treatment of patients with esophageal intramucosal and submucosal cancer: efficacy and factors influencing operative time[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(09): 675-679.

目的

探讨内镜黏膜下隧道法剥离术（ESTD）治疗食管黏膜内癌及黏膜下癌疗效及手术时间影响因素。

方法

回顾性分析宿迁市第一人民医院2015年11月至2018年12月收治食管黏膜内癌及黏膜下癌133例患者的临床资料，其中80例采用内镜黏膜下剥离术（ESD）治疗为A组，53例采用ESTD治疗为B组，比较2组切除效果、手术相关临床指标及手术相关并发症发生率；采用Logistic回归模型分析影响手术时间的因素。

结果

2组整块切除率和根治性切除率比较差异无统计学意义（P>0.05）；B组总手术时间和黏膜下剥离时间均少于A组（P<0.05）、剥离速度大于A组（P<0.05）；2组术后出血、术后发热及术后胸痛发生率比较，差异无统计学意义（P>0.05）；B组术中肌层损伤率和术中出血发生率均低于A组（P<0.05）。Logistic回归模型分析结果显示，应用ESTD和病灶面积<9 cm2是手术时间的独立影响因素（P<0.05）。

结论

ESTD治疗食管黏膜内癌及黏膜下癌可有效缩短总手术时间和黏膜下剥离时间，提高黏膜剥离速度，降低术中肌层损伤率和术中出血发生风险，且总体切除效果与ESD相当；手术时间与手术方式、病灶面积密切相关。

关键词: 内镜黏膜下隧道法剥离术, 食管肿瘤, 黏膜内癌, 黏膜下癌, 手术时间
Objective

To evaluate the efficacy of endoscopic submucosal tunnel dissection (ESTD) in the treatment of esophageal intramucosal and submucosal cancer and explore the factors influencing operation time.

Methods

A total of 133 patients with esophageal intramucosal and submucosal carcinomas treated at our hospital from November 2015 to December 2018 were retrospectively analyzed. Among them, 80 patients were treated by endoscopic submucosal dissection (ESD; group A) and 53 patients were treated by ESTD (group B). Logistic regression analysis was used to identify the factors influencing operation time.

Results

There was no significant difference between the two groups in the rates of total excision and radical excision (P>0.05); the total operation time and the time of submucosal dissection in group B were significantly less than those of group A (P<0.05). The speed of submucosal dissection in group B was significantly higher than that in group A (P<0.05). There was no significant difference in the rates of bleeding, fever, and chest pain after operation between the two groups (P>0.05). The rates of muscle layer injury and bleeding during operation in group B were significantly lower than those of group A (P<0.05). Logistic regression analysis showed that ESTD application and lesion area<9 cm2 were independent influencing factors of operation time (P<0.05).

Conclusion

ESTD for esophageal intramucosal and submucosal carcinomas can effectively shorten total operation time and submucosal dissection time, improve the speed of mucosal dissection, and reduce the incidence of intraoperative myometrial injury and intraoperative bleeding, with a similar overall resection effect to ESD. Operation time is closely related to the type of endoscopy and the area of lesion.

Key words: Endoscopic submucosal tunnel dissection, Esophageal neoplasms, Intramucosal cancer, Submucosal cancer, Operation time
表1 2组一般资料比较
组别 例数 男/女（例） 年龄（岁） 病灶面积（cm2） 病灶位置（例） 病理类型（例）
上1/3 中1/3 下1/3 黏膜内癌 黏膜下癌
A组 80 63/17 59.8±7.3 9.23±1.08 5 41 34 62 18
B组 53 41/12 59.3±7.1 9.70±1.16 2 28 23 40 13
统计值 ? χ2=0.36 t=0.678 t=0.841 χ2=0.363 χ2=0.073
P值 ? 0.849 0.496 0.292 0.916 0.786
表2 2组切除效果比较［例（%）］
组别 例数 整块切除率 根治性切除率
A组 80 80（100） 74（92.50）
B组 53 53（100） 52（98.11）
χ2值 ? - 2.015
P值 ? 1.000 0.157
表3 2组手术相关临床指标水平比较［M（QR）］
组别 例数 总手术时间（min） 黏膜下剥离时间（min） 黏膜下剥离速度（cm2/min）
A组 80 47.0（32.0~115.0） 35.0（27.0~93.0） 0.35（0.20~0.45）
B组 53 35.0（24.0~72.0） 30.0（14.0~55.0） 0.45（0.25~0.60）
Z值 ? -2.10 -2.88 -2.71
P值 ? 0.036 0.025 0.031
表4 2组手术相关并发症发生率比较［例（%）］
组别 例数 术中肌层损伤 术中出血 术后出血 术后发热 术后胸痛
A组 80 31（38.75） 28（35.00） 0（0.00） 4（5.00） 8（10.00）
B组 53 10（18.87） 9（16.98） 1（1.89） 5（9.43） 5（9.43）
χ2值 ? 5.910 5.155 1.521 0.993 0.012
P值 ? 0.015 0.023 0.217 0.319 0.914
表5 影响手术时间的多因素分析
影响因素 95%可信区间 OR值 P值
手术方式（ESTD/ESD） 1.11~7.26 2.89 0.02
病灶面积（<9 cm2/≥9 cm2） 2.09~12.80 5.47 0.00
病变部位 0.45~2.38 1.26 0.94
病变类型 0.19~1.24 0.58 0.08
术中出血 0.20~2.27 0.72 0.61
1
Huang R, Cai H, Zhao X, et al. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis [J]. Gastrointest Endosc, 2017, 86(3): 575-576.
2
Ominami M, Nagami Y, Shiba M, et al. Comparison of propofol with midazolam in endoscopic submucosal dissection for esophageal squamous cell carcinoma: a randomized controlled trial [J]. J Gastroenterol, 2018, 53(3): 397-406.
3
Ariyoshi R, Toyonaga T, Tanaka S, et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms extending to the cervical esophagus [J]. Endoscopy, 2017, 50(6): 613-617.
4
Dobashi A, Goda K, Yoshimura N, et al. Simplified criteria for diagnosing superficial esophageal squamous neoplasms using Narrow Band Imaging magnifying endoscopy [J]. World J Gastroenterol, 2016, 22(41): 9196-9204.
5
日本消化内镜学会.消化内镜指南 [M].沈阳: 辽宁科学技术出版社, 2014: 247-248.
6
Ishihara R, Matsuura N, Hanaoka N, et al. Endoscopic imaging modalities for diagnosing invasion depth of superficial esophageal squamous cell carcinoma: a systematic review and meta-analysis [J]. BMC Gastroenterol, 2017, 17(1): 24-30.
7
Wang J, Zhu XN, Zhu LL, et al. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions [J]. World J Gastroenterol, 2018, 24(26): 2878-2885.
8
Safiri S, Ayubi E. Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis: methodologic issues [J]. Gastrointest Endosc, 2017, 86(3): 575-576.
9
Zhai YQ, Li HK, Linghu EQ. Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms [J]. World J Gastroenterol, 2016, 22(1): 435-445.
10
Röhle G, Schlebusch H, Kruse R, et al. Routine endoscopy for esophageal cancer is suggestive for patients with oral, oropharyngeal and hypopharyngeal cancer [J]. PloS One, 2017, 12(1): e72097.
11
Sawas T, Visrodia KH, Zakko L, et al. Clutch cutter is a safe device for performing endoscopic submucosal dissection of superficial esophageal neoplasms: a western experience [J]. Dis Esophagus, 2018, 31(11): 1102-1107.
12
Abiko S, Shimizu Y, Miyamoto S, et al. Risk assessment of metachronous squamous cell carcinoma after endoscopic resection for esophageal carcinoma based on the genetic polymorphisms of alcoholdehydrogense-1B aldehyde dehydrogenase-2: temperance reduces the risk [J]. J Gastroenterol, 2018, 53(10): 1120-1130.
13
Kuwai T, Yamaguchi T, Imagawa H, et al. Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife [J]. World J Gastroenterol, 2018, 24(15): 1632-1640.
14
Akasaka T, Takeuchi Y, Uedo N, et al. ″Underwater″ endoscopic submucosal dissection for superficial esophageal neoplasms [J]. Gastrointest Endosc, 2017, 1(1): 171-180.
15
Tsou, YK, Chuang, WY, Liu CY, et al. Learning curve for endoscopic submucosal dissection of esophageal neoplasms [J]. Dis Esophagus, 2016, 29(6): 544-550.
16
Li QY, Meng Y, Xu YY, et al. Comparison of endoscopic submucosat tunneling dissection and thoraescopie enucleation for the treatment of esophageal submucosal tumors [J]．Gastrointest Endose, 2017, 86(3): 485-491.
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