两种内镜手术方式治疗食管胃交界处黏膜下肿瘤的疗效及术后并发症危险因素分析

目的 分析内镜黏膜下肿物挖除术（ESE）和隧道法内镜黏膜下肿物切除术（STER）治疗食管胃结合部（EGJ）黏膜下肿瘤（SMTs）的疗效,以及发生术后并发症的危险因素。方法 选择2018年1月－2019年1月该院收治的EGJ SMTs患者80例,根据治疗方式,分为ESE组和STER组,按照术后并发症的发生情况,分为无并发症组和并发症组。观察各组患者切除病变时间、金属夹缝合创面时间、手术时间、肿瘤大小、术中出血量和术后住院时间等手术指标。比较各组患者不良反应发生情况。分别于术后3、6和12个月进行随访,观察患者创面愈合情况,分析有无残留病变和复发情况。收集各组患者年龄、2型糖尿病、慢性肺病、手术时间、肿瘤大小和肿瘤病理性质等临床资料。采用多因素Logistic回归模型,分析发生术后并发症的影响因素。结果 ESE组切除病变时间短于STER组,金属夹缝合创面时间长于STER组,差异均有统计学意义（P < 0.05）,两组患者其他指标比较,差异无统计学意义（P > 0.05）。不同肿瘤大小患者中,ESE组切除病变时间短于STER组,金属夹缝合创面时间长于STER组,差异均有统计学意义（P < 0.05）,两组患者其他指标比较,差异均无统计学意义（P > 0.05）。术后12个月复查胃镜,患者手术创面愈合情况良好,未发现残留病变和复发情况。并发症组年龄明显大于无并发症组,手术操作时间长于无并发症组,肿瘤大小明显大于无并发症组,2型糖尿病和慢性肺病所占比例明显高于无并发症组,差异均有统计学意义（P < 0.05）。采用多因素Logistic回归分析发现,年龄、2型糖尿病、慢性肺病、手术时间和肿瘤大小是发生术后并发症的危险因素。结论 ESE和STER治疗EGJ SMTs安全、有效。年龄、2型糖尿病、慢性肺病、手术时间和肿瘤大小是发生术后并发症的危险因素,早期给予针对性治疗,有助于改善患者预后。

Efficacy of two kinds of endoscopic surgery on submucosal tumors at esophagogastric junction and risk factors of postoperative complications

Objective To analyze the efficacy of endoscopic submucosal excavation (ESE) and submucosal tunnel endoscopic resection (STER) on submucosal tumors (SMTs) at the esophagogastric junction (EGJ), and analyze the risk factors of postoperative complications.Methods 80 patients with EGJ SMTs from January 2018 to January 2019 were selected and divided into ESE group and STER group according to the treatment method, and were classified into non-complication group and complication group according to the occurrence of postoperative complications. The lesion resection time, metal clip suture wound time, operation time, tumor size, intraoperative blood loss and postoperative hospital stay were observed. The incidence of adverse reactions in each group was compared. The patients were followed up at 3, 6 and 12 months after operation to observe the wound healing and analyze the residual lesions and recurrence. Age, type 2 diabetes, chronic lung disease, operation time, tumor size, and tumor pathological characteristics were collected from each group. Multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative complications.Results The lesion resection time in ESE group was shorter than that in STER group, while the metal clip suture wound time was longer than that in STER group (P < 0.05), but there were no statistical differences in other indicators between the two groups (P > 0.05). Among patients with different tumor sizes, the lesion resection time in ESE group was shorter, while the metal clip suture wound time was longer than that in STER group (P < 0.05). There were no statistically significant differences in other indicators between the two groups (P > 0.05). Re-examination of gastroscopy at 12 months after surgery showed that the surgical wound of patients healed well, and no residual lesion or recurrence was found. The age of patients in complication group was significantly older than that in non-complication group, and the operation time was longer than that in non-complication group, and the tumor size was significantly larger than that in non-complication group, and the proportions of type 2 diabetes and chronic lung disease were significantly higher than those in non-complication group (P < 0.05). Multivariate Logistic regression analysis showed that age, type 2 diabetes, chronic lung disease, operative time and tumor size were risk factors of postoperative complications.Conclusion ESE and STER are effective and safe in the treatment of EGJ SMTs. Age, type 2 diabetes, chronic lung disease, operation time and tumor size are all risk factors for postoperative complications. Early targeted treatment can help improve the prognosis of patients.