全周及近全周型食管早期癌和癌前病变内镜射频消融术后食管狭窄影响因素的病例对照研究

Factors influencing esophageal stenosis after endoscopic radiofrequency ablation for total or near total circumferential early esophageal cancer and precancerous lesions: a case‑control study

摘要:

目的 探讨全周及近全周型食管早期癌和癌前病变内镜射频消融术后食管狭窄发生的影响因素。方法 2018年11月至2022年4月，因全周及近全周型早期食管鳞状细胞癌或上皮内瘤变，在东南大学附属中大医院消化科行内镜射频消融术治疗的37例病例纳入病例对照研究，按是否发生术后食管狭窄分成2组，即发生术后食管狭窄组（病例组，n=15）和未发生术后食管狭窄组（对照组，n=22），分析组间一般资料、内镜表现、手术过程等是否存在差异。结果 在性别（P=0.708）、年龄（t=1.106，P=0.413）、抽烟或饮酒（P=0.329）、术前病理（P=0.194）、环周情况（P=1.000）、巴黎分型（P=0.379）、病变长度（t=-0.825，P=0.927）、消融长度（t=-0.134，P=0.723）、消融次数（P=0.306）、每次消融间距（P=0.500）方面，2组间差异均无统计学意义；在浸润深度方面，2组间差异有统计学意义（P=0.021）。结论 对于全周及近全周型食管早期癌和癌前病变，病变浸润深度可能影响内镜射频消融术后食管狭窄的发生，并可能有随着浸润加深术后食管狭窄发生率上升的趋势，但还需进一步研究证实。

Abstract:

Objective To investigate the factors influencing the occurrence of esophageal stenosis after endoscopic radiofrequency ablation (RFA) for total or near total circumferential early esophageal cancer and precancerous lesions. Methods Between November 2018 and April 2022, 37 patients who underwent RFA for early esophageal squamous cell carcinoma or intraepithelial neoplasia at Zhongda Hospital, Southeast University were included in a case-control study, and were divided into two groups based on the occurrence of postoperative esophageal stricture: the group with postoperative esophageal stenosis (case group, n=15) and the group without postoperative esophageal stenosis (control group, n=22). The differences in general information, endoscopic findings, and surgical procedures between the two groups were analyzed. Results There was no significant difference in gender (P=0.708), age (t=1.106, P=0.413), smoking or drinking (P=0.329), preoperative pathology (P=0.194), circumferential situation (P=1.000), Paris type (P=0.379), lesion length (t=-0.825, P=0.927), ablation length (t=-0.134, P=0.723), ablation times (P=0.306), or interval between each ablation (P=0.500) between the two groups; however, there was significant difference in invasion depth between the two groups (P=0.021). Conclusion For total or near total circumferential early esophageal cancer and precancerous lesions, the depth of lesion infiltration may affect the occurrence of esophageal stenosis after RFA. The likelihood of esophageal stenosis may rise with increased infiltration depth, suggesting a need for further research to validate these findings.