临床研究
Copyright ©The Author(s) 2022.
世界华人消化杂志. 2022-07-08; 30(13): 587-598
在线出版 2022-07-08. doi: 10.11569/wcjd.v30.i13.587
表1 治愈性与非治愈性切除的特征比较
治愈性切除(n = 62)非治愈性切除(n = 22)P
年龄, n(%)0.005
<70岁55(88.7%)13(59.1%)
≥70岁7(11.3%)9(40.9%)
环周比例, n(%)<0.001
<1/244(71.0%)5(22.7%)
1/2-2/311(17.7%)6(27.3%)
>2/37(11.3%)11(50.0%)
病灶位置, n(%)0.381
胸上段4(5.5%)2(9.1%)
胸中段33(53.2%)8(36.4%)
胸下段25(40.3%)12(54.5%)
镜下病灶大小, n(%)0.041
<2 cm42(67.7%)9(13.4%)
≥2 cm20(32.3%)13(59.1%)
外观形态, n(%)0.857
Ⅰ型4(6.5%)1(4.5%)
0-Ⅱa型16(25.8%)5(22.7%)
0-Ⅱb型27(43.5%)8(36.4%)
0-Ⅱc型4(6.5%)2(9.1%)
多类型11(17.7%)6(27.3%)
伴有溃疡, n(%)0.219
38(61.3%)10(45.5%)
24(38.7%)12(54.5%)
病灶抬举情况, n(%)0.371
良好58(93.5%)19(86.4%)
不良4(6.5%)3(13.6%)
表2 非治愈性切除的二元Logistic回归分析结果
单因素分析多因素分析
OR95CI%POR95CI%P
年龄
<70岁1.000-1.000-
≥70岁5.4401.709-17.3170.0042.8240.710-11.2250.140
性别
1.000-
1.9440.650-5.8200.234
环周比例
<1/21.000-1.000-
1/2-2/34.8001.234-18.6710.0243.1280.708-13.8270.133
>2/313.8293.678-52.986<0.0017.9581.757-36.0530.007
病灶抬举
阳性1.000-
不良2.2890.470-11.1610.305
病灶位置
胸上段1.000-
胸中段0.4850.075-3.1300.447
胸下段0.9600.154-5.9940.965
镜下大小
<2 cm1.000-1.000-
≥2 cm3.0331.113-8.2700.0301.6820.486-5.8220.420
外观形态
Ⅰ型1.000-
Ⅱa型1.2500.112- 13.9240.856
Ⅱb型1.1850.115- 12.1690.886
Ⅱc型2.0000.125- 31.9750.624
多类型2.1820.197- 24.2080.525
伴有溃疡
1.000-
1.9000.711-5.0750.200
表3 12例追加手术或放化疗患者的情况及原因
编号病灶抬举病理类型浸润深度切缘脉管侵袭治愈性追加治疗类型原因
1+1M3+-6放疗转移
2-2M1+-外科手术残留
3+M3--7外科手术残留, 浸润至SM2
4-3SM2++外科手术残留
5+4SM2--放疗残留
6+SM2--放疗异时性癌
7+SM2--外科手术复发
8+中腺5SM2-+放疗残留
9-SM2--外科手术复发
10-SM1--放疗肺转移
11+SM2--放疗残留
12+SM2+-放疗残留
表4 追加和未追加外科手术或放化疗的病灶特征比较
总计未追加组追加组P
年龄0.046
<70岁68(81.0%)61(84.7%)7(58.3%)
≥70岁16(19.0%)11(15.3%)5(41.7%)
病灶位置0.244
6(7.1%)6(8.3%)0(0%)
41(48.8%)37(51.4%)4(33.3%)
37(44.0%)29(40.3%)8(66.7%)
环周比例0.002
<1/249(58.3%)47(65.3%)2(16.7%)
1/2-2/317(20.2%)13(18.1%)4(33.3%)
>2/318(21.4%)12(16.7%)6(50.0%)
外观形态0.250
Ⅰ型5(6.0%)4(5.6%)1(8.3%)
Ⅱa型21(25.0%)19(26.4%)2(16.7%)
Ⅱb型35(41.7%)32(44.4%)3(25.0%)
Ⅱc型6(7.1%)5(6.9%)1(8.3%)
多分型17(20.2%)12(16.7%)5(41.7%)
伴有溃疡1.000
48(57.1%)41(56.9%)7(58.3%)
36(42.9%)31(43.1%)5(41.7%)
抬举情况0.007
阳性77(91.7%)69(95.8%)8(66.7%)
不良7(8.3%)3(4.2%)4(33.3%)
分化情况<0.001
良好79(94.0%)71(98.6%)8(66.7%)
不良5(6.0%)1(1.4%)4(33.3%)
肿瘤浸润深度<0.001
M153(63.1%)52(72.2%)1(8.3%)
M210(11.9%)10(13.9%)0(0%)
M36(7.1%)5(6.9%)1(8.3%)
SM13(3.6%)1(1.4%)2(16.7%)
SM212(14.3%)4(5.6%)8(66.7%)
肿瘤大小0.478
<10 mm10(11.9%)10(13.9%)0(0%)
10 mm-20 mm41(48.8%)35(48.6%)6(5.0%)
20 mm-30 mm16(19.0%)14(19.4%)2(16.7%)
>30 mm17(20.2%)13(18.1%)4(33.3%)
切缘0.064
(-)72(85.7%)64(88.9%)8(66.7%)
(+)12(14.3%)8(11.1%)4(33.3%)
距水平切缘(mm)3.0(2.0,5.0)3.0(2.0,8.0)5.0(2.0,6.5)0.531
距垂直切缘(mm)0.8(0.23,5.0)5.0(0.8,8.0)0.55(0.2,3.9)0.568
脉管侵袭0.052
(-)81(96.4%)71(98.6%)10(83.3%)
(+)3(3.6%)1(1.4%)2(16.7%)
治愈性切除<0.001
62(73.8%)60(83.3%)2(16.7%)
22(26.2%)12(16.7%)10(83.3%)
表5 需要追加手术或放化疗的危险因素分析
单因素分析多因素分析
OR95%CIPOR95%CIP
年龄
<70岁1.000-1.000-
≥70岁3.9611.063-14.7540.0404.2102.219-39.6910.049
环周比例
<1/21.000-1.000-
1/2-2/37.2311.189-43.9670.0326.0470.238-153.1180.275
>2/311.7502.101-65.7030.0055.1110.197-132.3060.326
抬举情况
阳性1.000-1.000-
不良11.5002.173-60.8670.00418.1711.044-316.3870.047
分化程度
良好1.000-1.000-
不良35.5003.524-357.6430.0025.0810.177-146.0720.343
浸润深度
M1.000-1.000-
SM167.0004.148-1082.2780.00345.4280.735-2807.220.070
SM267.00010.546-425.660<0.00138.7812.221-677.3220.012
脉管侵袭
(-)1.000-1.000-
(+)14.2001.177-171.2820.0378.4750.065-1102.470.390

引文著录: 古丽斯坦·阿布拉, 宋文轩, 刘航, 任祥凤, 陈鑫. 早期食管病变内镜黏膜下剥离术后辅助治疗人群的预测模型. 世界华人消化杂志 2022; 30(13): 587-598