食管全周浅表癌内镜黏膜下剥离术后长期保留胃管对食管狭窄的预防及治疗作用

Long‑term indwelling gastric tube for prevention and treatment of esophageal stricture after endoscopic submucosal dissection for esophageal circumferential superficial cancer

摘要:

为探讨食管全周浅表癌行内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）后长期保留胃管对食管狭窄预防及治疗的影响，回顾性分析2018年1月—2021年12月在南京医科大学第一附属医院行ESD的食管全周浅表癌患者，术后置入胃管患者15例（胃管置入组），无胃管置入患者23例（无胃管置入组），比较两组患者基础情况、病变位置、病理分期、术后并发症、食管狭窄程度（进水情况）、疼痛情况、住院次数及医疗费用等资料。结果显示，两组患者在年龄、性别、病变位置及术后病理分期的构成方面差异无统计学意义（P>0.05）。与无胃管置入组相比，胃管置入组患者可进水率较高（11/15比6/23，P<0.05），发生疼痛次数较少［（7.3±3.1）次比（10.7±3.6）次，t=3.00，P<0.05］，ESD后至食管支架置入前及置入后的住院次数和医疗总费用均明显低于无胃管置入组（P<0.05）。ESD后迟发性出血率、穿孔率以及首次狭窄出现时间，两组差异均无统计意义（P>0.05）。研究结果初步表明食管全周病变患者行ESD后长期保留胃管可减轻食管狭窄程度，具有较良好的安全性。

Abstract:

To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups (P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group (P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups (P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.