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内镜黏膜下隧道切除术治疗浅表食管鳞状细胞癌的疗效和安全性：倾向评分匹配分析
DOI：
10.1016/j.gie.2017.03.001
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发表时间：
2017-11-01
影响因子：
7.7
通讯作者：
Han, Ying
中科院分区：
文献类型：
--
作者：
Huang, Rui;Cai, Hongwei;Han, Ying
背景和目的：食管镜下黏膜下剥离术(ESD)由于管壁较薄、管腔狭窄，在技术上具有挑战性。隧道技术是以前提出的。本研究旨在评价隧道技术在浅表食管鳞癌ESD治疗中的疗效。方法：研究对象为2013年10月至2015年9月接受ESD治疗的浅表性食管鳞癌患者。倾向评分匹配被用来补偿年龄、性别、切除标本大小和病理上的差异。配对后将隧道ESD组与常规ESD组的治疗结果与常规统计方法进行比较。为了进一步探索与手术时间相关的潜在变量，进行了单因素和多因素Logistic回归分析。结果：共有115个病变进入分析。倾向分数匹配分析产生了38对匹配。两组在肿瘤整块切除率、完全切除率、治愈率方面无明显差异。隧道ESD组ESD操作时间为38.0(29.5~46.0)分钟，常规ESD组为48.0(35.4~83.3)分钟(P=0.006)。隧道组术后出血、穿孔、胸痛等不良反应发生率无差异，但肌肉损伤率(28.9%vs52.6%；P=.036)和电凝钳使用频率(36.8%vs65.8%；P=.012)均低于隧道组。在手术时间的多元回归分析中，隧道ESD技术(优势比[OR]3.42；95%可信区间[CI]，1.32~8.85；P=.011)和标本大小<40 mm(OR 8.74；95%CI，1.30~58.5；P=0.026)与手术时间有关。结论：内窥镜下黏膜下隧道剥离术缩短了手术时间，减少了对肌层的损伤，提高了手术的有效性和安全性。
Background and Aims: Esophageal endoscopic submucosal dissection (ESD) is technically challenging because of the thinner wall and narrow lumen. The tunnel technique was proposed previously. This current retrospective study aimed to evaluate the efficacy of the tunnel technique in ESD of superficial esophageal squamous cell carcinoma (ESCC).Methods: Patients who underwent ESD for superficial ESCC between October 2013 and September 2015 were included in the study. Propensity score matching was used to compensate for the differences in age, sex, resected specimen size, and pathology. Treatment outcomes were compared with conventional statistic methods between the tunnel ESD group and conventional ESD group after matching. To further explore the potential variables relevant to procedure time, univariate and multivariate logistic regression analyses were applied.Results: A total of 115 lesions were included in the analysis. Propensity score matching analysis created 38 matched pairs. There was no difference on en bloc resection rate, complete resection rate, and curative rate between the 2 groups. The ESD procedure time was 38.0 (range 29.5-46.0) minutes in the tunnel ESD group and 48.0 (35.4-83.3) minutes in the conventional ESD group (P = .006). There was no difference in adverse events including postprocedural bleeding, perforation, and chest pain, but a lower rate of muscular injury (28.9% vs 52.6%; P = .036) and a less-frequent use of coagulation forceps (36.8% vs 65.8%; P = .012) were shown in the tunnel ESD group. In multivariate regression analysis for procedure time, the tunnel ESD technique (odds ratio [OR] 3.42; 95% confidence interval [CI], 1.32-8.85; P = .011) and specimen size < 40 mm (OR 8.74; 95% CI, 1.30-58.5; P = .026) were associated with a shorter procedure time.Conclusions: The endoscopic submucosal tunnel dissection improved the efficacy and safety of the ESD procedure by shortening the procedure time and reducing injury to the muscular layer.