一个多中心的回顾性研究,在食道内镜下粘膜下切割中,在中度环形缺陷切除后形成狭窄的危险因素
Tsugumi Habu1, Osamu Goto2,3, Toshiyuki Yoshio4
1Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan.
Surgical endoscopy
|November 6, 2025
概括
在食道内镜下粘膜解剖 (ESD) 后的术后狭窄是令人担忧的,特别是在大型缺陷的情况下. 更大的缺陷和更长的手术时间是狭窄的关键风险因素,需要采取积极的预防策略.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 在瘤学瘤学.
背景情况:
- 内镜下粘膜切割 (ESD) 有效治疗表面食道癌.
- 手术后食道狭窄是ESD后的一个显著并发症.
- 在中度 (50-75%) 周围粘膜缺陷中,狭窄的危险因素需要进一步调查.
研究的目的:
- 在ESD后在患有50-75%周围粘膜缺陷的患者中确定术后食道狭窄的独立风险因素.
- 评估类固醇使用在预防这个患者群体狭窄症中的作用.
主要方法:
- 一个多中心的回顾性观察性研究,涉及513名接受食道ESD的患者,其中50-75%是周围粘膜缺陷.
- 从2018年4月到2022年3月收集的数据来自19个机构.
- 用多变量和灵敏度分析 (ridge-penalized logistic regression) 来识别风险因素被使用.
主要成果:
- 术后狭窄发生在5%的患者中.
- 确定的独立风险因素包括先前的内镜治疗,宫食道病变,大周围缺陷和更长的程序持续时间.
- 灵敏度分析证实,较大的周长缺陷 (>5/8) 和较长的手术时间 (>120分钟) 是狭窄的强有力的预测因素.
结论:
- 在食道ESD之后,更大的外围粘膜缺陷和更长的程序持续时间是狭窄症的最重要的危险因素.
- 对高风险患者来说,积极的狭窄性预防策略至关重要,即使缺陷的周长小于75%也如此.
- 在具有特定高风险因素的患者中,使用类固醇并不能完全减轻狭窄风险.
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