老年早期大面积食管癌患者ESD术后狭窄的危险因素分析

Analysis of risk factors for stenosis after ESD in elderly patients with early large-area esophageal cancer

中文关键词: 老年  早期大面积食管癌  ESD  食管狭窄  相关因素  HAAM移植  预防

英文关键词: elderly  early large-area esophageal cancer  ESD  esophageal stenosis  related factor  HAAM transplanta-tion  prevention

中文摘要:

      目的 探究老年早期大面积食管癌患者内镜黏膜下剥离术(Endoscopic submucosal dissection,ESD)术后狭窄的危险因素分析及人脱细胞羊膜(Human Acellular Amniotic Membrane,HAAM)预防效果.方法 回顾性分析2021年1月—2024年12月在绵阳四○四医院接受ESD治疗的98例老年早期大面积食管癌患者的临床资料.根据患者术后食管狭窄的发生情况分为发生组和未发生组,比较2组患者的一般临床资料、病变特征、手术情况和术后恢复情况.采用二元Logistic回归分析影响老年早期大面积食管癌患者ESD术后食管狭窄的独立危险因素.结果 98例老年早期大面积食管癌患者经ESD治疗,术后发生食管狭窄有35例,占35.71％;63例术后未发生食管狭窄,占64.29％.发生组的食管病变周径范围(＞3/4)的比率、肿瘤浸润深度(M3+SM1)的比率、术中伤及固有肌层的比率、未HAAM移植的比率、术后4周内出现局部或全身感染的比率、术后24 h内出现迟发性出血的比率、术后8周内严格避免平卧体位的比率高于未发生组(P＜0.05).Logistic回归分析显示,食管病变周径范围、肿瘤浸润深度、术中伤及固有肌层情况、术后4周内出现局部或全身感染发生情况、24 h内迟发性出血情况、术后8周内平卧体位情况是老年早期大面积食管癌患者ESD术后食管狭窄的影响因素(P＜0.05).结论 老年早期大面积食管癌患者ESD术后食管狭窄与食管病变周径范围、肿瘤浸润深度、术中伤及固有肌层、HAAM移植、存在术后感染、存在迟发性出血、术后平卧体位等因素相关.同时,HAAM移植具有良好的预防效果,值得在临床中进一步推广和应用.

英文摘要:

      Objective To investigate the risk factors for stenosis after endoscopic submucosal dissection(ESD)in eld-erly patients with early large-area esophageal cancer,and evaluate the preventive effect of human acellular amniotic membrane(HAAM).Methods The clinical data of 98 elderly patients with early large-area esophageal cancer who received ESD in Mi-anyang 404 Hospital from January 2021 to December 2024 were retrospectively analyzed.According to the occurrence of post-operative esophageal stenosis,they were divided into occurrence group and non-occurrence group.The general clinical data,le-sion characteristics,surgical conditions and postoperative recovery conditions were compared between the two groups.Binary Logistic regression analysis was used to analyze the independent risk factors for esophageal stenosis after ESD in elderly patients with early large-area esophageal cancer.Results Among 98 elderly patients with early large-area esophageal cancer after ESD,postoperative esophageal stenosis occurred in 35 cases(35.71％),while 63 ones(64.29％)did not develop stenosis.The proportions of esophageal lesion circumference range(＞3/4),tumor invasion depth(M3+SM1),intraoperative muscularis propria layer injury,non-HAAM transplantation,local or systemic infection within 4 weeks after surgery,delayed bleeding within 24 hours after surgery and strict avoidance of supine position within 8 weeks after surgery in the occurrence group were significantly higher than those in the non-occurrence group(P＜0.05).Logistic regression analysis revealed that the circumfer-ence range of esophageal lesions,tumor invasion depth,intraoperative muscularis propria layer injury,local or systemic infec-tion within 4 weeks after surgery,delayed bleeding within 24 hours after surgery and supine position within 8 weeks after sur-gery were influencing factors for esophageal stenosis in elderly patients with early large-area esophageal cancer after ESD(P＜0.05).Conclusion Esophageal stenosis after ESD in elderly patients with early large-area esophageal cancer is related to the circumference range of esophageal lesions,depth of tumor invasion,intraoperative muscularis propria layer injury,HAAM transplantation,postoperative infection,delayed bleeding,postoperative supine position and other factors.HAAM transplanta-tion has a good preventive effect and is worthy of further promotion and application in clinical practice.