作者：李云1，刘超1，刘琳2，夏秀丽1，徐超1，闫玲新1

单位：1.邯郸市中心医院 消化内科一病区，河北 邯郸 056001； 2.邯郸市中心医院 消化内科二病区，河北 邯郸 056001

Authors:  LI Yun1, LIU Chao1, LIU Lin2, XIA Xiuli1, XU Chao1, YAN Lingxin1

Unit:   1.First Ward of Gastroenterology Department, Handan Central Hospital, Handon 056001, Hebei, China； 2.Second Ward of Gastroenterology Department, Handan Central Hospital, Handon 056001, Hebei, China

摘要：

目的  探讨内镜下多隧道粘膜剥离术(endoscopic multi-tunnel mucosal dissection, ESMTD)对早期食管癌患者并发症及复发的影响。方法  选取2016年1月至2018年1月本院早期食管癌患者100例，依据随机数字表分为ESMTD组和内镜下黏膜剥离术(endoscopic mucosal dissection, ESD)组，每组50例，ESMTD组给予ESMTD治疗，ESD组给予ESD治疗，比较两组肿瘤标志物[鳞状上皮细胞癌抗原(squamous cell carcinoma antigen, SCCAG)、转化生长因子-α(transforming growth factoralpha, TGF-α)]及手术、并发症、复发情况。结果  ESMTD组和ESD组术后SCCAG、TGF-α明显低于术前，ESMTD组术后SCCAG、TGF-α明显低于ESD组，差异有统计学意义(P<0.05);ESMTD组切除标本面积、切除速度、整块切除率、根治性切除率明显高于ESD组，ESMTD组术中出血量、手术时间、住院时间、并发症率明显低于ESD组，差异有统计学意义(P<0.05)，ESMTD组复发率低于ESD组，但差异无统计学意义(P>0.05)。结论  ESMTD可有效降低早期食管癌患者手术创伤及SCCAG、TGF-α水平，有利于减少并发症及促进康复，且复发少，值得临床推广。

关键词： 内镜下多隧道粘膜剥离术; 内镜下黏膜剥离术; 早期食管癌; 并发症; 复发

Abstract：

Objective  To discuss the effect of endoscopic multi-tunnel mucosal dissection (ESMTD) on complications and recurrence of early esophageal cancer. Methods  100 patients with early esophageal cancer in our hospital from January 2016 to January 2018 were selected, they were divided into ESMTD group and endoscopic mucosal dissection (ESD)group according to the random number table, 50 cases in each group. The ESMTD group was treated with ESMTD, the ESD group was treated with ESD, the tumor markers [squamous cell carcinoma antigen (SCCAG), transforming growth factor-alpha (TGF-alpha)], operation, complications and recurrence were compared between the two groups. Results  The SCCAG, TGF -a in ESMTD group and ESD group after operation were significantly lower than those in before operation, the SCCAG, TGF-a in ESMTD group after operation were significantly lower than those in ESD group, the difference was statistically significant (P<0.05). The area of excised specimens, the speed of excision, the rate of total excision and the rate of radical excision in ESMTD group were significantly higher than those in ESD group, and the intraoperative bleeding volume, operation time, hospitalization time and complication rate in ESMTD group were significantly lower than those in ESD group, the difference was statistically significant (P<0.05), the recurrence rate in ESMTD group was lower than that in ESD group, but there was no significant difference (P>0.05). Conclusions  ESMTD can effectively reduce the surgical trauma and the SCCAG, TGF-alpha, TSGF levels in patients with early esophageal cancer, which is conducive to reducing complications and promoting rehabilitation, with less recurrence, it’s worth for further clinical promotion.

Key Words:  Endoscopic multi-tunnel mucosal dissection; Endoscopic mucosal dissection; Early esophageal cancer; Complications; Recurrence