吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响

摘要 目的：探讨吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响。方法：纳入2020年3月-2021年9月在南京医科大学第一附属医院消化内科住院确诊为食管早期肿瘤及癌前病变拟行内镜治疗的60例患者,根据有无合并吞咽困难将患者分为吞咽困难组和无吞咽困难组,分别比较两组患者在临床特征、高分辨率食管测压（HRM）参数以及焦虑自评量表（SAS）、抑郁自评量表（SDS）、胃食管反流病自评量表（GERDQ）评分的差异,分析HRM异常参数与原发病灶参数的相关性。结果：吞咽困难组患者的食管下括约肌（LES）中心点位置低于无吞咽困难组患者,LES静息压、LES残余压、无效吞咽百分比显著高于无吞咽困难组患者（P<0.05）,HRM异常参数与原发病灶参数之间未见明显相关性（P>0.05）,吞咽困难组患者的SAS、SDS评分高于无吞咽困难组（P<0.05）,而两组患者GERDQ评分比较差异无统计学意义（P>0.05）。结论：食管早期肿瘤及癌前病变患者出现的吞咽困难症状与合并的异常食管动力有关,同时在一定程度上影响了患者的心理状态,对患者的临床相关症状无明显影响。

Effects of Dysphagia on Esophageal Motility, Psychological Status and Clinical Symptoms in Patients with Early Esophageal Tumors and Precancerous Lesions

ABSTRACT Objective: To investigate the effects of dysphagia on esophageal motility, psychological state and clinical symptoms in patients with early esophageal tumors and precancerous lesions. Methods: 60 patients with early esophageal tumors and precancerous lesions who were diagnosed in the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University from March 2020 to September 2021 were included. The patients were divided into dysphagia group and non dysphagia group according to the presence or absence of dysphagia. The differences in clinical characteristics, high-resolution esophageal manometry (HRM) parameters, self rating Anxiety Scale (SAS), self rating Depression Scale (SDS) and self rating gastroesophageal reflux disease scale (gerdq) were compared between the two groups. The correlation between HRM abnormal parameters and primary lesion parameters was analyzed. Results: The central position of lower esophageal sphincter (LES) in dysphagia group was lower than that in non dysphagia group. Les resting pressure, Les residual pressure and the percentage of ineffective swallowing were significantly higher than those in non dysphagia group(P<0.05). There was no significant correlation between HRM abnormal parameters and primary lesion parameters (P>0.05). The scores of SAS and SDS in dysphagia group were higher than those in non dysphagia group (P<0.05), but there was no significant difference in gerdq score between the two groups (P>0.05). Conclusion: Dysphagia in patients with early esophageal tumors and precancerous lesions is related to the combined abnormal esophageal motility. At the same time, it affects the psychological state of patients to a certain extent, and has no significant effect on the clinical symptoms of patients.