单个宽隧道结合线夹牵引的内镜黏膜下剥离术在大面积早期食管癌及癌前病变中的应用研究

Application of single‑wide‑tunnel endoscopic submucosal dissection with single‑clip‑line traction for large early esophageal cancer and precancerous lesions

摘要:

目的 评价单个宽隧道结合线夹牵引的内镜黏膜下剥离术（single‑wide‑tunnel endoscopic submucosal dissection with single‑clip‑line traction，W‑ESTD）治疗大面积（≥3/4环周）早期食管癌及癌前病变的临床效果。方法 回顾性分析2018年1月至2023年1月期间在南京医科大学附属淮安第一医院行消化内镜治疗的大面积早期食管癌或癌前病变的患者资料，按操作方式分为W‑ESTD组及双隧道法内镜黏膜下剥离术（endoscopic submucosal double‑tunnel dissection， D‑ESTD）组。比较两组患者在手术速度、整块切除率、R0切除率、治愈性切除率、术中及术后并发症等方面的差异。结果 共纳入44例大面积早期食管癌或癌前病变患者，其中W‑ESTD组23例，D‑ESTD组21例。两组患者基线资料比较差异均无统计学意义（P>0.05）。W‑ESTD组的手术速度为（29.97±11.89）mm²/min，D‑ESTD组的手术速度为（22.65±6.30）mm²/min，差异有统计学意义（t=2.580，P=0.014）。两组在病变整块切除率［95.7%（22/23）比100.0%（21/21），P=1.000］、R0切除率［87.0%（20/23）比90.5%（19/21），P=1.000］及治愈性切除率［73.9%（17/23）比85.7%（18/21），P=0.462］方面差异无统计学意义。两组均无复发病例。W‑ESTD组与D‑ESTD组分别有3例和5例患者术中出现肌层损伤，分别有11例和8例术后出现食管狭窄，但组间差异均无统计学意义（P>0.05）。结论 与D‑ESTD相比，W‑ESTD可显著提高手术速度，是一种安全有效的治疗大面积早期食管癌及癌前病变的方法。

Abstract:

Objective To evaluate the clinical efficacy of single‑wide‑tunnel endoscopic submucosal dissection with single‑clip‑line traction (W‑ESTD) for the treatment of early esophageal cancer and precancerous lesions with large area (≥ 3/4 circumference). Methods A retrospective analysis was performed on patient data of large early esophageal cancer or precancerous lesions treated with digestive endoscopy at the Affiliated Huai""an NO.1 People""s Hospital of Nanjing Medical University from January 2018 to January 2023. Patients were divided into W‑ESTD group and endoscopic submucosal double‑tunnel dissection (D‑ESTD) group based on the technique used. Surgical speed, en bloc resection rate, R0 resection rate, curative resection rate, intraoperative and postoperative complications were compared between the two groups. Results A total of 44 patients with large early esophageal cancer or precancerous lesions were included in this study, including 23 cases in the W‑ESTD group and 21 cases in the D‑ESTD group. There was no statistically significant difference in baseline data between the two groups (P>0.05). The operating speeds of W‑ESTD and D‑ESTD groups were 29.97±11.89 mm²/min and 22.65±6.30 mm²/min, respectively, with significant difference (t=2.580, P=0.014). There was no statistically significant difference between the two groups in terms of en bloc resection rate [95.7% (22/23) VS 100.0% (21/21), P=1.000], R0 resection rate [87.0% (20/23) VS 90.5% (19/21), P=1.000], or curative resection rate [73.9% (17/23) VS 85.7% (18/21), P=0.462]. No recurrence occurred. Intraoperative muscular injury occurred in 3 cases in the W‑ESTD group and 5 cases in the D‑ESTD group, and postoperative esophageal stricture occurred in 11 cases and 8 cases respectively, with no significant differences between the two groups (P>0.05). Conclusion Compared to D‑ESTD, W‑ESTD can significantly improve surgical speed and demonstrate itself as a safe and effective approach for treating large early esophageal cancer and precancerous lesions.