作者：孙静, 肖淑珺

单位：南京医科大学附属泰州人民 医院消化科， 江苏 泰州225300

Authors: Sun Jing，Xiao Shujun

Unit: Department of Gastroenterology，Taizhou People's Hospital，Nanjing Medical University，Taizhou 225300，Jiangsu，China

摘要：

目的 探讨早期食管癌内镜黏膜下剥离术（ESD）术后中重度疼痛的危险因素，并建立早期食管癌ESD术后中重度疼痛的列线图模型。方法 选取2018年4月至2021年10月进入我院行ESD治疗246例早期食管癌患者作为模型组，将2020年11月至2022年5月收治的行ESD治疗的70例早期食管癌患者作为验证组。采用Logistic回归分析筛选早期食管癌ESD术后中重度疼痛的危险因素，采用R软件建立早期食管癌ESD术后中重度疼痛的列线图模型，并验证列线图模型。结果 246例早期食管癌ESD患者中有70例患者ESD术后发生中重度疼痛，中重度疼痛的发生率为28.46%(70/246)。Logistic回归分析结果显示，女性、年龄<60岁、睡眠状况较差、城市户籍、术前心理状态不佳、病变环周比≥3/4及黏膜下层纤维化等是早期食管癌ESD术后中重度疼痛的危险因素（P<0.05）。根据Logistic回归分析结果建立早期食管癌ESD术后中重度疼痛的列线图模型，结果显示，模型组的C-index为0.772 (95%CI:0.742～0.803)，验证组的C-index为0.784 (95%CI:0.755～0.813)；校正曲线显示模型组和验证组的实际值与预测值的拟合度皆较好；模型组和验证组的曲线下面积分别是0.753和0.762。结论 女性、年龄<60岁、睡眠状况较差、城市户籍、术前心理状态不佳、病变环周比≥3/4及黏膜下层纤维化等是早期食管癌ESD术后中重度疼痛的危险因素，本研究构建的列线图模型可对早期食管癌ESD术后中重度疼痛的预防起到积极的帮助作用。 

关键词：早期食管癌； 内镜黏膜下剥离术； 疼痛； 影响因素； 列线图模型

Abstract：

Objective To investigate the risk factors of moderate to severe pain after endoscopic submucosal dissection （ESD） for early esophageal cancer，and to establish a nomogram model for moderate to severe pain after ESD for early esophageal cancer. Method A total of 246 patients with early esophageal cancer who were admitted to our hospital for ESD from April 2018 to October 2021 were selected as the model group，and 70 patients with early esophageal cancer who underwent ESD from November 2020 to May 2022 were selected as the model group. as a verification group. Logistic regression analysis was used to screen the risk factors of moderate to severe pain after ESD for early esophageal cancer ，and R software was used to establish a nomogram model of moderate to severe pain after ESD for early esophageal cancer ，and to verify the nomogram model. Result Among the 246 patients with early esophageal cancer undergoing ESD，70 patients developed moderate to severe pain after ESD，and the incidence of moderate to severe pain was 28.46%（70/246）. Logistic regression analysis showed that female，age<60 years old，poor sleep status，urban household registration，poor preoperative psychological state，lesion circumference ratio≥3/4，and submucosal fibrosis were the most important factors in early esophageal cancer after ESD. Risk factors for severe pain （P<0.05）. According to the logistic regression analysis results，a nomogram model of moderate to severe pain after ESD for early esophageal cancer was established. The results showed that the C -index of the model group was 0.772（95%CI：0.742-0.803），and the C-index of the validation group was 0.784（95%CI：0.755-0.813）; the calibration curve showed that the actual and predicted values of the model group and the validation group were well fitted; the AUC of the model group and the validation group were 0.753 and 0.762，respectively. Conclusion Female，age<60 years old，poor sleep status，urban household registration，poor preoperative psychological state，lesion circumference ratio≥3/4，and submucosal fibrosis are risk factors for moderate to severe pain after ESD for early esophageal cancer. The nomogram model constructed in this study can play a positive role in the prevention of moderate to severe pain after ESD for early esophageal cancer.

Key Words: Early esophageal cancer; Endoscopic submucosal dissection; Pain; Influencing factors; Nomogram model