T1bSM2期食管鳞状细胞癌内镜治疗的安全性和有效性分析

doi:10.3877/cma.j.issn.1674-6899.2020.03.010

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03): 173 -176. doi: 10.3877/cma.j.issn.1674-6899.2020.03.010

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T1bSM2期食管鳞状细胞癌内镜治疗的安全性和有效性分析

吕昆明 ¹, 袁静 ², 柴宁莉 ³, 冯秀雪 ³, 卢忠生 ³, 张文刚 ³, 汤小伟 ³, 陈倩倩 ³, 令狐恩强 ³ ^, ^†(

)

^1. 100853 北京，解放军医学院；100853 北京，解放军总医院第二医学中心消化内科
^2. 100853 北京，解放军总医院第一医学中心病理科
^3. 100853 北京，解放军总医院第一医学中心消化内科

收稿日期:2020-04-19 出版日期:2020-06-30
通信作者: 令狐恩强
基金资助:
国家重点研发计划(2016YFC1303601)

The safety and efficacy of endoscopic treatment of T1bSM2 esophageal squamous cell carcinoma

Kunming Lyu ¹, Jing Yuan ², Ningli Chai ³, Xiuxue Feng ³, Zhongsheng Lu ³, Wengang Zhang ³, Xiaowei Tang ³, Qianqian Chen ³, Enqiang Linghu ³ ^, ^†( )

^1. Chinese PLA Medical School, Beijing 100853, China; Department of Gastroenterology, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
^2. Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
^3. Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China

Received:2020-04-19 Published:2020-06-30
Corresponding author: Enqiang Linghu
About author:
Corresponding author: Linghu Enqiang, Email: linghuenqiang@vip.sina.com

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目的

回顾性分析内镜切除术治疗T1bSM2期(黏膜下层≥200 μm)早期食管鳞状细胞癌的安全性、有效性。

方法

选取2009年1月至2017年7月于解放军总医院第一医学中心接受内镜切除术治疗且术后病理提示病变累及M3层(黏膜肌层)、SM1层(黏膜下层<200 μm)和SM2层(黏膜下层≥200 μm)的79例患者为研究对象，根据浸润深度分为相对适应证组和拓展适应证组，分析比较两组患者的基本资料及术后并发症的差异，Kaplan-Meier生存分析总体生存率及无进展生存率。

结果

两组患者的基本资料、术后并发症、预后、总体生存率及无进展生存率比较，差异无统计学意义。

结论

对于T1bSM2期食管鳞状细胞癌，内镜切除术也是一种可以选择的治疗方式。

关键词: 内镜切除术, 内镜黏膜剥离术, 早期食管鳞状细胞癌, 拓展适应证

Objective

To analysis of the safety and efficacy of endoscopic resection in the treatment of early esophageal squamous cell carcinoma of stage T1bSM2 (submucosa ≥200 μm).

Methods

The clinical data of 79 patients undergoing endoscopic resection surgery and postoperative pathology showed that the lesions involved the M3 layer (mucosal muscle layer) , SM1 layer (submucosal layer <200 μm) and SM2 layer (submucosal layer ≥200 μm)was retrospectively analyzed.According to the depth of infiltration, the patients was divided into two groups including relative indication group and expanded the indication group , The basic data and postoperative complications of the two groups were analyzed and compared between the two groups.Kaplan-Meier survival analysis was employed to analyze the overall survival rate and progression-free survival rate.

Results

There was no significant difference in basic data, postoperative complications, prognosis, overall survival rate and progression-free survival rate between the two groups.

Conclusions

Endoscopic treatment can be used as a optional method in patients with T1bSM2 stage esophageal squamous cell carcinoma.

Key words: Endoscopic resection, Endoscopic submucosal dissection, Early esophageal squamous cell carcinoma, Expanded the indication

表1 相对适应证组与拓展适应证组基本资料比较

变量		相对适应证组(57例)	拓展适应证组(22例)	χ²/t值	P值
性别(男/女，例)		42/15	19/3 1.451	0.228	?
年龄(岁， ±s)		61.2±7.6	63.4±9.6	-1.035	0.304
病变占环周比例[例(%)]		?	?	0.201	0.654
	<3/4周	44(77.2%)	18(81.8%)	?	?
	≥3/4周	13(22.8%)	4(18.2%)	?	?
病变位置[例(%)]		?	?	5.105	0.078
	胸上段	2(3.5%)	4(18.2%)	?	?
	胸中段	22(38.6%)	6(27.3%)	?	?
	胸下段	33(57.9%)	12(54.5%)	?	?
分化程度[例(%)]		?	?	1.296	0.523
	低分化	19(33.3%)	10(45.5%)	?	?
	中分化	37(64.9%)	12(54.5%)	?	?
	高分化	1(1.8%)	0(0)	?	?
浸润性生长方式[例(%)]		?	?	0.750	0.687
	A	39(68.4%)	13(59.1%)	?	?
	B	15(26.3%)	7(31.8%)	?	?
	C	3(5.3%)	2(9.1%)	?	?
脉管浸润阳性[例(%)]		4(7.0%)	1(4.5%)	1.120	0.290
完全切除[例(%)]		51(89.5%)	16(72.7%)	2.278	0.131

表1 相对适应证组与拓展适应证组基本资料比较

变量		相对适应证组(57例)	拓展适应证组(22例)	χ²/t值	P值
性别(男/女，例)		42/15	19/3 1.451	0.228	?
年龄(岁， ±s)		61.2±7.6	63.4±9.6	-1.035	0.304
病变占环周比例[例(%)]		?	?	0.201	0.654
	<3/4周	44(77.2%)	18(81.8%)	?	?
	≥3/4周	13(22.8%)	4(18.2%)	?	?
病变位置[例(%)]		?	?	5.105	0.078
	胸上段	2(3.5%)	4(18.2%)	?	?
	胸中段	22(38.6%)	6(27.3%)	?	?
	胸下段	33(57.9%)	12(54.5%)	?	?
分化程度[例(%)]		?	?	1.296	0.523
	低分化	19(33.3%)	10(45.5%)	?	?
	中分化	37(64.9%)	12(54.5%)	?	?
	高分化	1(1.8%)	0(0)	?	?
浸润性生长方式[例(%)]		?	?	0.750	0.687
	A	39(68.4%)	13(59.1%)	?	?
	B	15(26.3%)	7(31.8%)	?	?
	C	3(5.3%)	2(9.1%)	?	?
脉管浸润阳性[例(%)]		4(7.0%)	1(4.5%)	1.120	0.290
完全切除[例(%)]		51(89.5%)	16(72.7%)	2.278	0.131

表2 相对适应证组与拓展适应证组术后并发症及预后比较[例(%)]

项目		相对适应证组(57例)	拓展适应证组(22例)	χ²/t值	P值
不良事件		?	?	?	?
	出血	0(0.0%)	0(0.0%)	?	?
	穿孔	0(0.0%)	0(0.0%)	?	?
	食管狭窄	19(33.3%)	4(18.2%)	1.766	0.184
预后		?	?	?	?
	异时复发	2(3.5%)	4(18.2%)	3.003	0.083
	转移	1(1.8%)	1(4.5%)	0.501	0.479
	死亡	2(3.5%)	3(13.6%)	1.304	0.254
因食管癌死亡		0(0.0%)	1(4.5%)	2.624	0.105

表2 相对适应证组与拓展适应证组术后并发症及预后比较[例(%)]

项目		相对适应证组(57例)	拓展适应证组(22例)	χ²/t值	P值
不良事件		?	?	?	?
	出血	0(0.0%)	0(0.0%)	?	?
	穿孔	0(0.0%)	0(0.0%)	?	?
	食管狭窄	19(33.3%)	4(18.2%)	1.766	0.184
预后		?	?	?	?
	异时复发	2(3.5%)	4(18.2%)	3.003	0.083
	转移	1(1.8%)	1(4.5%)	0.501	0.479
	死亡	2(3.5%)	3(13.6%)	1.304	0.254
因食管癌死亡		0(0.0%)	1(4.5%)	2.624	0.105

图1 总体生存率的Kaplan-Meier生存曲线比较

图2 无进展生存率的Kaplan-Meier生存曲线比较

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[1]	吕昆明, 令狐恩强. 早期和浅表性食管鳞状细胞癌内镜治疗现状[J]. 中华腔镜外科杂志(电子版), 2019, 12(03): 185-188.

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