早期食管癌术后食管狭窄发生情况及影响因素分析

Occurrence and influencing factors of esophageal stenosis after surgery for early esophageal cancer

  • 摘要:
    目的 分析早期食管癌术后食管狭窄发生情况及影响因素。
    方法 选取2019年1月—2021年1月在本院进行内镜黏膜下剥离术的285例早期食管癌患者为研究对象, 根据术后食管狭窄发生情况将其分为对照组237例(未发生食管狭窄)和研究组48例(发生食管狭窄)。比较2组患者手术时间、术中出血量、生活质量; 分析食管狭窄的影响因素。
    结果 与对照组相比,研究组手术时间更长,术中出血量更多,心理、环境、生理、社会维度评分更低,差异有统计学意义(P<0.05)。单因素分析显示,内镜黏膜下剥离术患者术后食管狭窄与性别、临床分期、病理类型、饮酒史、美国麻醉医师协会(ASA)分级以及麻醉方式无相关性(P>0.05); 年龄≥60岁、存在固有肌层损伤、病变环周范围>3/4、存在营养不良、组织浸润深度为M3+SM1、病变纵向长径>40 mm患者的食管狭窄发生率较高(P<0.05)。多因素Logistics回归分析显示,营养不良、年龄≥60岁、病变环周范围>3/4、固有肌层损伤、组织浸润深度为M3+SM1、病变纵向长径>40 mm为内镜黏膜下剥离术后食管狭窄发生的主要影响因素(P<0.05)。
    结论 早期食管癌患者通过内镜黏膜下剥离术诊治后发生食管狭窄与固有肌层损伤、营养不良、年龄≥60岁、组织浸润深度为M3+SM1、病变环周范围>3/4、病变纵向长径>40 mm等因素相关,可据此对其进行早期预防、控制,降低术后食管狭窄发生率。

     

    Abstract:
    Objective To analyze the occurrence status and influencing factors of esophageal stenosis after surgery for early esophageal cancer.
    Methods A total of 285 patients with early esophageal cancer with endoscopic submucosal dissection (ESD) in the hospital from January 2019 to January 2021 were selected as research objects, and they were divided into control group with 237 cases (without esophageal stenosis) and study group with 48 cases (with esophageal stenosis) according to the occurrence of esophageal stenosis after surgery. The operation time, intraoperative blood loss and quality of life were compared between the two groups. The influencing factors of esophageal stenosis were analyzed.
    Results Compared with the control group, the study group had longer operation time, more intraoperative blood loss, and lower scores in psychological, environmental, physiological and social dimensions, and the between-group differences were statistically significant (P<0.05). Univariate analysis showed that esophageal stenosis after ESD had no correlations with gender, clinical stage, pathological type, history of drinking, the American Society of Anesthesiologists (ASA) classification, and anesthesia method (P>0.05). Patients aged ≥60 years old, damage of the muscularis propria, circumferential extent of lesion >3/4, malnutrition, tissue infiltration depth of M3+SM1, and longitudinal length of lesion >40 mm had a higher incidence of esophageal stenosis (P<0.05). Multivariate Logistics regression analysis showed that malnutrition, age ≥60 years, circumferential extent of lesion >3/4, damage of the muscularis propria, tissue infiltration depth of M3+SM1, and longitudinal length of lesion >40 mm were the main influencing factors for esophageal stenosis after ESD (P<0.05).
    Conclusion The occurrence of esophageal stenosis after ESD in patients with early esophageal cancer is related to factors such as damage of the muscularis propria, malnutrition, age ≥60 years, tissue infiltration depth of M3+SM1, circumferential extent of lesion >3/4, and longitudinal length of lesion >40 mm. Based on these factors, early prevention and control can be carried out to reduce the incidence of esophageal stenosis after surgery.

     

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