内镜黏膜下剥离术治疗消化道早期癌及癌前病变长期疗效的单中心回顾性队列分析

发布时间：2019-02-12 21:21

【摘要】：目的研究内镜黏膜下剥离术(ESD)治疗消化道早癌或癌前病变的长期疗效以及术后复发的影响因素。方法收集73例患者的临床及随访资料。采用Kaplan-Meier法,Log-rank和Breslow检验,以及Cox风险比例模型进行统计学分析。结果胃和结直肠ESD术后中位无复发生存时间(DFS)大于该研究最长随访时间(65个月),食管中位生存时间为44.5个月;与胃和结直肠相比,食管ESD术后DFS明显减少(χ~2=12.61,P=0.000;χ~2=7.09,P=0.008);病灶异型程度(浸润深度)和病灶面积影响ESD术后DFS(P=0.027,OR=2.38,95%CI:1.10~5.12;P=0.074,OR=0.90,95%CI:0.80~1.01)。结论 ESD术是切除消化道早期癌和癌前病变并维持长期不复发的有效内镜下手术方法 ;异型程度(浸润深度)是影响ESD术后DFS的独立危险因素;病灶面积在影响ESD术后的DFS方面具有临床意义。
[Abstract]:Objective to study the long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early or precancerous lesions of digestive tract and the influencing factors of postoperative recurrence. Methods the clinical and follow-up data of 73 patients were collected. Kaplan-Meier method, Log-rank and Breslow test, and Cox risk ratio model were used for statistical analysis. Results the median recurrence free survival time (DFS) after gastric and colorectal ESD was longer than the longest follow-up time (65 months) in this study. The median survival time of esophagus was 44.5 months. Compared with stomach and colorectal, DFS was significantly decreased after esophageal ESD (蠂 ~ 2 ~ 2 ~ (12.61) P ~ + 0.000; 蠂 ~ 2 ~ 2 ~ 2 ~ (7.09) P ~ (0. 008), and the degree of lesion heterogeneity (depth of infiltration) and lesion area affected DFS (P ~ (0.027) ~ (2.38) ~ 95 ~ (?) CI _ (1.105.12) after ESD. P = 0.074 / 0.9095 / CI: 0.801.01) Conclusion ESD is an effective endoscopic procedure for the resection of early digestive tract cancer and precancerous lesions without recurrence for a long time and the degree of heterogeneity (depth of infiltration) is an independent risk factor for DFS after ESD. The focus area has clinical significance in influencing DFS after ESD.
【作者单位】：浙江省人民医院(杭州医学院附属人民医院)消化内科;浙江省人民医院(杭州医学院附属人民医院)临床研究所;
【基金】：浙江省科技厅面上社会发展项目(No:2009C33082) 浙江省自然科学基金(No:LQ17H160016) 浙江省医药卫生科技计划(No:2015KYA029)
【分类号】：R735

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