Page 120 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第44卷第11期
·1586 · Journal of Nanjing Medical University（Natural Sciences） 2024年11月

·临床研究·

非治愈性ESD治疗对追加食管癌根治术后并发症的影响

卢荣鑫，刘锦源，薛 磊，范 骏，骆金华 *
南京医科大学第一附属医院胸外科，江苏 南京 210029

［摘 要］ 目的：探讨内镜下黏膜下剥离术（endoscopic submucosal dissection，ESD）对追加胸腹腔镜联合食管癌根治术后并发
症的影响，并进一步研究二次手术合适的间隔时间。方法：收集2019年10月—2022年10月在南京医科大学第一附属医院行
胸腹腔镜联合食管癌根治手术患者831例，其中52例在食管癌根治术前行ESD手术，其余779例未接受ESD手术，以倾向性评
分进行1∶3匹配，将全部患者分为ESD+OP 组（52例）和Non⁃ESD+OP 组（149例），对比两组患者术后并发症发病率，研究ESD
术后不同时间点行食管癌根治术的优劣。结果：ESD+OP组患者食管癌根治术后的并发症发生率高于Non⁃ESD+OP组（59.6%
vs. 33.6%，P=0.001），其中肺部感染（26.9% vs. 10.7%，P=0.001）、吻合口瘘（13.5% vs. 4.7%，P=0.033）发生率明显增加。与其余
时间段相比，ESD术后2~4周追加食管癌根治术并发症发生率较低（38.1% vs. 75.0%，P=0.033），手术较为安全。结论：非治愈
性ESD治疗会增加食管癌根治术后并发症及手术风险；ESD 术后 2~4 周追加食管癌根治术较为安全，可有效降低手术风险。
［关键词］ 食管癌根治术；非治愈性ESD；术后并发症；时间间隔
［中图分类号］ R735.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）11⁃1586⁃05
doi：10.7655/NYDXBNSN240663

Effect of non⁃curative ESD on postoperative complications after additional esophagectomy
LU Rongxin，LIU Jinyuan，XUE Lei，FAN Jun，LUO Jinhua *
Department of General Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To evaluate the effect of non⁃curative endoscopic submucosal dissection（ESD）on postoperative complications
after additional thoraco⁃laparoscopic esophagectomy and to investigate the optimal interval between non⁃curative ESD and additional
esophagectomy. Methods：A total of 831 patients with esophageal cancer who underwent thoraco⁃laparoscopic esophagectomy in our
hospital between October 2019 and October 2022 were collected. Among them，52 patients underwent ESD prior to esophagectomy，
while 779 patients did not. Propensity score matching（PSM）was performed at a 1∶3 ratio，dividing the patients into an ESD+OP group
（52 cases）and a Non⁃ESD+OP group（149 cases）. The incidence of postoperative complications was compared between the two groups，
and the outcomes of esophagectomy performed at different time points after ESD were evaluated. Results：The incidence of
postoperative complications was higher in the ESD + OP group than the Non ⁃ ESD + OP group（59.6% vs. 33.6% ，P=0.001），with
significantly increased rates of pulmonary infection（26.9% vs. 10.7%，P=0.001）and anastomotic leakage（13.5% vs. 4.7%，P=0.033）.
The lowest complication rate（38.1% vs. 75.0%，P=0.033）and the safest outcomes were observed when esophagectomy was performed 2
to 4 weeks after ESD. Conclusion：The non ⁃ curative ESD may increased the postoperative complications and the risk of
esophagectomy. Performing esophagectomy 2 to 4 weeks after ESD is relatively safer and can effectively reduce surgical risk.
［Key words］ esophageal cancer；non⁃curative ESD；postoperative complications；time interval
［J Nanjing Med Univ，2024，44（11）：1586⁃1589，1598］

食管癌是常见的消化道恶性肿瘤之一，其发病率 随着食管癌早期诊断率的不断提高，内镜下黏膜下
位居我国恶性肿瘤的第5位，死亡率位居第4位 ［1-2］ 。 剥离术（endoscopic submucosal dissection，ESD）已经
成为早期食管癌治疗的重要手段。ESD 具有创伤

［基金项目］ 吴阶平医学基金课题（320.6750.19008） 小、住院时间短、经济负担轻等诸多优点。研究表
∗ 明，T1a⁃M1、M2 分期食管鳞癌淋巴结转移风险较
通信作者（Corresponding author），E⁃mail：ljhua@126.com