经内镜黏膜下剥离术治疗食管早癌及癌前病变的预后及影响因素

发布时间：2018-06-30 06:16

  本文选题：内镜黏膜下剥离术 + 食管早癌　； 参考：《中国人民解放军医学院》2016年硕士论文

【摘要】：背景与目的近10年迅速发展起来的内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)可对大面积消化道早癌或癌前病变实现治愈性切除,其治疗效果和价值已逐渐被临床证实,但对于ESD治疗的远期疗效,国内报道不一,缺乏大宗病例的长期跟踪观察和验证。本课题旨在研究经ESD治疗早期食管癌及癌前病变的预后及影响因素。方法收集177例(切除病灶186个)2008年1月—2013年6月因食管早癌及癌前病变在解放军总医院消化内镜中心行ESD诊治患者的临床资料,全部病灶位于胸段食管,胸部上段8个,胸部中段123个,胸部下段55个。切除病变平均最大直径2.9 cm (1.0-6.0 cm),切除面积(2.9×2.1) cm2(1.0×0.8-6.0×5.0 cm2),手术时间平均77(20～448)min。治愈性切除153例病灶(82.26%,153/186),术中发生并发症4例,其中出血1例、穿孔3例,经治疗均痊愈,147例都进入随访组；非治愈性切除25例病灶(13.44%,25/186),其中5例补充外科手术,2例行术后放疗,余跟踪随访；无法评估8例病灶(4.30%,8/186),全部进入随访组。对其预后及随访情况回顾性地进行分析总结。结果治愈性切除(R0)153例病灶(82.26%,153/186),术中发生并发症4例,经治疗均痊愈,153例都进入随访组；非治愈性切除(R1)25例病灶(13.44%,25/186),其中5例补充外科手术,2例行术后放疗,余跟踪随访；无法评估(Rx)8例病灶(4.30%,8/186),全部进入随访组.共计随访166例病灶(89.25%,166/186),其中门诊120例,电话随访46例,失访20例,随访的时间范围为1～64个月,中位随访的时间为39个月；随访6月16例,6～12月29例,12～36月71例,36月50例；术后食管狭窄11例,病变复发6例病灶(3.23%,6/166),其中2例接受外科手术,4例行再次ESD术；3～5年生存率100%。剥离食管病变环周的范围(P=0.018)为出现并发症的相关影响因素。将食管分为难于操作组(食管上段及下段)和易于操作组(食管中段),对两组并发症发生率、病灶大小、环周范围、病理、手术操作时间以及患者性别、年龄等因素进行分析,差异均无显著性.对病理进行多因素方差分析,结果为病理(OR:7.472,95% CI:2.321-68.08, p=0.021)是影响食管病变ESD术后复发的相关因素。结论ESD治疗早期食管癌及癌前病变的治愈率高、发生远期并发症机率低、复发率低、生存率高,预后及远期疗效良好,值得在临床上更广泛地进行推广。其中病理为食管病变ESD术后出现复发发生的相关影响因素.
[Abstract]:Background and objective the rapid development of endoscopic submucosal dissection (endoscopic submucosal dissection,) in recent 10 years can be used to cure large areas of early cancer or precancerous lesions of digestive tract. Its therapeutic effect and value have been gradually proved by clinical practice. However, there are different reports on the long-term efficacy of ESD and lack of long-term follow-up and verification of large numbers of cases. The aim of this study was to study the prognosis and influencing factors of early esophageal cancer and precancerous lesions treated by ESD. Methods from January 2008 to June 2013, 177 patients with early esophageal cancer and precancerous lesions were treated with ESD at the endoscopy center of the Chinese PLA General Hospital. All the lesions were located in the thoracic esophagus, with 8 lesions in the upper thoracic segment. There were 123 middle thoracic segments and 55 lower thoracic segments. The mean maximum diameter of lesion was 2.9 cm (1.0-6.0 cm),) cm2 (1.0 脳 0.8-6.0 脳 5.0 cm2), and the average operative time was 77 (20448) min. One hundred and fifty-three lesions (82.26 / 153 / 186) were cured and complications occurred in 4 cases, including hemorrhage in 1 case, perforation in 3 cases, and noncurable resection in 25 cases (13.444.25 / 186). 8 lesions (4.30% / 186) could not be evaluated and all of them were included in the follow-up group. The prognosis and follow-up were retrospectively analyzed and summarized. Results there were 153 cases (82.26 / 153 / 186) of cured resection (82.26 / 153 / 186), 4 cases of intraoperative complications (all cured by treatment), and 25 cases of non-curable resection (R1) (13.4444 / 25 / 186), 5 cases of which were treated with postoperative radiotherapy, and the rest were followed up. Unable to evaluate (RX) 8 lesions (4.30% / 186), all of them were included in the follow-up group. A total of 166 lesions (89.25 / 166 / 186) were followed up, of which 120 were outpatient, 46 by telephone and 20 by telephone. The follow-up time ranged from 1 to 64 months, with a median follow-up time of 39 months, followed up in 16 cases from 6 to 12 months in 71 cases from 12 to 36 months, and in 36 months in 50 cases. Postoperative esophageal stenosis occurred in 11 cases, and recurrence in 6 cases (3.23% / 166). Among them, 2 cases underwent surgery and 4 cases underwent ESD again. The survival rate of 3 ~ 5 years was 100%. The extent of circumferential dissection of esophageal lesions (P0. 018) was associated with complications. The esophagus was divided into two groups: the difficult operation group (upper and lower esophagus) and the easy-to-operate group (middle esophagus). The incidence of complications, lesion size, circumferential range, pathology, operative time, gender and age of the patients were analyzed. There was no significant difference between the two groups. The multivariate analysis of variance showed that pathology (OR: 7.47295% CI: 2.321-68.08, p0.021) was a related factor affecting the recurrence of esophageal diseases after ESD. Conclusion ESD treatment of early esophageal cancer and precancerous lesions has a high cure rate, low rate of long-term complications, low recurrence rate, high survival rate, good prognosis and long-term curative effect. It is worth popularizing more widely in clinical practice. The pathology was related to the recurrence of esophageal lesions after ESD.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.1
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本文编号：2085271