[1]黄涛 张红 杨国栋 冯迎春 凌颖 蒋玲 冯志松*.早期食管癌及癌前病变多环黏膜切除60例报告[J].中国微创外科杂志,2015,15(6):492-496.
　Huang Tao,Zhang Hong,Yang Guodong,et al.Multi-band Mucosectomy for Early-stage Esophageal Carcinoma and Precancerous Lesions: Report of 60 Cases[J].Chinese Journal of Minimally Invasive Surgery,2015,15(6):492-496.
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早期食管癌及癌前病变多环黏膜切除60例报告 ()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
15
期数:
2015年6期
页码:
492-496
栏目:
临床论著
出版日期:
2015-06-20

文章信息/Info

Title:
Multi-band Mucosectomy for Early-stage Esophageal Carcinoma and Precancerous Lesions: Report of 60 Cases
作者:
黄涛 张红 杨国栋 冯迎春 凌颖 蒋玲 冯志松*
川北医学院附属医院消化内科，南充637000
Author(s):
Huang Tao;  Zhang Hong;  Yang Guodong;  et al.
Department of Gastroenterology, Affiliated Hospital of Chuanbei Medical College, Nanchong 637000, China
关键词:
食管癌; 癌前病变; 多环黏膜切除术
Keywords:
Esophageal cancer; Precancerous lesions; Multi-band mucosectomy
分类号:
R735.1
文献标志码:
A
摘要:
目的探讨多环黏膜切除术（multiband mucosectomy，MBM）治疗早期食管癌及癌前病变的疗效和安全性。方法我院2011年12月~2013年10月对60例胃镜及病理确定的早期食管癌及癌前病变，胃镜下1.2%卢戈液染色，确定病灶并标记切除范围，安装多环黏膜切除器，自口侧将病灶上缘及标记点上皮层吸入，释放橡胶环完成套扎，圈套器电凝切除，收集组织标本；重复吸引、套扎、切除至病灶完全切除。结果60例共84处病灶，1例术中出血转胸外科手术，其余59例83处（98.3%）病灶均一次性成功切除。使用皮圈1~12发，共用皮圈289发，平均4.8发/例。手术时间10~60 min，平均23.5 min；切除长度1.0~10 cm，宽度不超过3/4食管周径；3例（5.0%）术中明显出血，2例术中止血，1例转外科手术，术后无一例出血。术中穿孔1例（1.7%），置入全覆膜金属支架保守治疗成功。术后病理：全部标本基底无癌残留，原位癌9例，高级别瘤变29例，低级别瘤变12例，角化不全6例，颗粒细胞瘤1例，息肉/炎性增生3例。59例随访1~23个月，2例（34%）食管狭窄，经探条扩张吞咽困难缓解，无一例局部复发及发现淋巴结转移。结论MBM治疗早期食管癌及癌前病变近期疗效确切，安全可靠；技术要求相对较低，值得广泛推广。
Abstract:
ObjectiveTo study the efficacy and safety of multi-band mucosectomy (MBM) for the treatment of early-stage esophageal carcinoma and precancerous lesions.MethodsA total of 60 cases of early-stage esophageal carcinoma and precancerous lesions (diagnosed pathologically) were admitted from December 2011 to October 2013 in this hospital. The scope of lesion was determined by using 1.2% Lugo staining and the target area was delineated with coagulation marking. After the installation of polycyclic mucosal resection device, the mucosa was sucked into the cap, a rubber band was released, pseudopolyps were removed with the hexagonal snare, and tissue samples were collected. The above mentioned procedures were repeated until the complete removal of the lesion.ResultsThere were a total of 84 lesions in the 60 cases. Except a conversion to thoracic surgery was conducted in 1 case because of bleeding, the remaining 83 lesions in 59 cases (98.3%) were successfully removed at one-time. The operation used a total of 289 hair aprons, with 1-12 rounds in each case (mean, 4.8 rounds/case). The operation time was 10-60 minutes (mean, 235 minutes). The resection was 1.0-10 cm in length and <3/4 esophageal circumference in width. Intraoperative massive hemorrhage occurred in 3 cases (5.0%), 2 of which were given intraoperative hemostasis and 1 of which underwent conversion to open surgery. No postoperative hemorrhage happened. Intraoperative perforation was found in 1 case (1.7%), which was cured by using all-covered metal stent implantation for conservative treatment. Postoperative pathological outcomes showed no residual cancer in basal part in all specimens, and 9 cases of carcinoma in situ, 29 cases of high-grade neoplasia, 12 cases of low-grade neoplasia, 6 cases of parakeratosis, 1 case of granular cell tumor, and 3 cases of polyp/inflammatory hyperplasia. Follow-up examinations in 59 cases for 1-23 months showed 2 cases (3.4%) of esophageal stenosis, which were relieved after bougienage. No local recurrence or lymph node metastases was found.ConclusionMBM treatment for earlystage esophageal cancer and precancerous lesions is safe, effective, and reliable, being worthy of wide promotion.

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备注/Memo

备注/Memo:
*通讯作者，E-mail：fengzhisong@medmail.com.cn
更新日期/Last Update: 2015-06-20