改良多隧道法内镜黏膜下剥离术治疗长度大于8 cm食管全周浅表癌的临床研究

A clinical research of modified endoscopic submucosal multi‑tunnel dissection for superficial circumferential esophageal cancer over 8 cm in length

摘要:

目的 探讨改良多隧道法内镜黏膜下剥离术（endoscopic submucosal multi‑tunnel dissection，ESMTD）治疗轴向长度>8 cm食管全周浅表癌的有效性和安全性。方法 回顾性分析南京医科大学第一附属医院2018年1月—2021年12月治疗的79例病变长度>8 cm的食管全周浅表癌患者资料。根据治疗方法将患者分为改良ESMTD组（32例）和外科手术组（47例），对比分析两组的整块切除率、完全切除率、手术时间、住院时间、医疗费用及手术相关并发症等指标。结果 改良ESMTD组和外科手术组的整块切除率均为100.0%（χ2=0.000，P=1.000），完全切除率分别为96.9%（31/32）和97.9%（46/47）（χ2=0.000，P=1.000）；改良ESMTD组手术时间短于外科手术组［（150.5±17.2）min比（185.8±15.2）min，t=9.527，P<0.001］，术后发生迟发性出血［3.1%（1/32）比10.6%（5/47），χ2=0.648，P=0.421］、迟发性穿孔［3.1%（1/32）比4.3%（2/47），χ2=0.000，P=1.000］发生率与外科手术组差异无统计学意义，术后C反应蛋白［（64.3±6.9）mg/L比（89.2±7.4）mg/L，t=15.634，P<0.001］、中性粒细胞水平［（10.1±1.4）×109/L比（13.1±1.2）×109/L，t=15.083，P<0.001］低于外科手术组。改良ESMTD组住院时间短于外科手术组［（9.2±1.2）d比（11.5±1.2）d，t=8.363，P<0.001］，医疗费用少于外科手术组［（3.2±0.3）万元比（5.9±0.6）万元，t=26.384，P<0.001］。结论 与传统外科手术相比，改良ESMTD治疗轴向长度>8 cm的全周食管浅表癌疗效确切，安全性好，且住院时间短，医疗费用少，保留了食管的完整性，提高了患者术后生活质量，具有较良好的临床应用价值。

Abstract:

Objective To investigate the efficacy and safety of modified endoscopic submucosal multi-tunnel dissection (ESMTD) for superficial circumferential esophageal cancer with an axial length of more than 8 cm. Methods Data of 79 patients with superficial circumferential esophageal cancer with lesion length of more than 8 cm who were treated in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. Patients were divided into modified ESMTD group (32 cases) and surgery group (47 cases) according to the treatment. The en bloc resection rate, complete resection rate, operation time, hospitalization time, medical expenses, incidence of procedure-related complications of the two groups were compared. Results The en bloc resection rate in the modified ESMTD group and the surgery group were both 100.0% (χ2=0.000, P=1.000), and the complete resection rate were 96.9% (31/32) and 97.9% (46/47) (χ2=0.000, P=1.000), respectively. The operation time in the modified ESMTD group was shorter than that in the surgery group (150.5±17.2 min VS 185.8±15.2 min, t=9.527, P<0.001). The incidence of delayed bleeding [3.1% (1/32) VS 10.6% (5/47), χ2=0.648, P=0.421] and delayed perforation [3.1% (1/32) VS 4.3% (2/47), χ2=0.000, P=1.000] in the two groups were not statistically different. Postoperative C-reactive protein (64.3±6.9 mg/L VS 89.2±7.4 mg/L, t=15.634, P<0.001) and neutrophil levels [(10.1±1.4)×109/L VS (13.1±1.2)×109/L, t=15.083, P<0.001] were lower in the modified ESMTD group than those in the surgery group. The hospital stay of the modified ESMTD group was shorter than that of the other group (9.2±1.2 d VS 11.5±1.2 d, t=8.363, P<0.001), and the medical expense was less than that of the surgery group (32±3 thousand yuan VS 59±6 thousand yuan, t=26.384, P<0.001). Conclusion Compared with traditional surgery, modified ESMTD for the treatment of superficial circumferential esophageal cancer with an axial length >8 cm has definite curative effect, safety, short hospital stay, and low medical costs, and can preserve the integrity of the esophagus and improve the quality of life of patients. It has good clinical application value.