[1]王伟,何晓荣①,王域玲,等.内镜黏膜下剥离术在食管早期癌及癌前病变治疗中的价值[J].中国微创外科杂志,2017,17(5):393-401.
　Wang Wei*,He Xiaorong,Wang Yuling*,et al.On Value of Endoscopic Submucosal Dissection in the Treatment of Early Esophageal Cancer and Precancerous Lesions[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):393-401.
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内镜黏膜下剥离术在食管早期癌及癌前病变治疗中的价值()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
393-401
栏目:
临床论著
出版日期:
2017-07-14

文章信息/Info

Title:
On Value of Endoscopic Submucosal Dissection in the Treatment of Early Esophageal Cancer and Precancerous Lesions
作者:
王伟; 何晓荣①; 王域玲; 施新岗*; 李兆申
上海长海医院消化内科，上海200433
Author(s):
Wang Wei*;  He Xiaorong;  Wang Yuling*;  et al.
*Department of Gastroenterology, Shanghai Changhai Hospital, Shanghai 200433, China
关键词:
食管早期癌; 癌前病变; 内镜黏膜下剥离术
Keywords:
Early esophageal cancer; Precancerous lesions; Endoscopic submucosal dissection
文献标志码:
A
摘要:
目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗食管早期癌及癌前病变的安全性、有效性。方法回顾性分析2012年3月~2014年8月接受ESD治疗的171例食管早期癌及癌前病变的临床资料，分析病灶特征、ESD技术特征、术中与术后并发症及处理、术后复发等指标。结果171例均顺利完成ESD治疗，平均手术时间65.0 min（12~272 min）。术中穿孔5例（2.9%），术后延迟性出血3例（1.8%），术后延迟性穿孔1例（0.6%）。病灶整块切除165例（96.5%），完整切除159例（93.0%）。术后病理提示高级别上皮内瘤变85例（49.7%），高分化癌70例（40.9%），中分化癌16例（9.4%）。9例（5.3%）因基底部切缘和（或）脉管癌细胞累及追加外科手术。术后2个月食管狭窄37例（21.6%），其中切除范围<1/2周的患者术后食管狭窄发生率为2.3%（2/86），1/2周~3/4周为30.0%（15/50），>3/4周为45.8%（11/24），全周型为81.8%（9/11）。重度食管狭窄19例（11.1%），均接受扩张治疗，平均扩张1.9次（1~6次），其中12例因扩张效果欠佳行食管金属支架置入术，平均支架置入2.2次（1~6次）。术后平均随访40.4月（24~54个月），复发6例（35%），均接受二次内镜治疗。结论ESD治疗食管早期病变是安全有效的。大面积ESD术后食管狭窄发生率高，往往需要多次食管扩张或支架置入治疗。术后病理是判断病灶完整切除的重要依据，定期内镜随访是监测病灶残留与复发的有效手段。
Abstract:
ObjectiveTo evaluate the safety and effectiveness of endoscopic submucosal dissection (ESD) in the treatment of early esophageal cancer (EEC) and precancerous lesions.MethodsClinical data of 171 patients who underwent ESD for EEC and precancerous lesions in our center from March 2012 to August 2014 were reviewed, with emphasis on the features of esophageal lesions, the technique features of ESD, intraoperative and post-operative complications and post-operation recurrence.ResultsThe 171 patients received ESD treatment smoothly, with an intraoperative perforation rate of 2.9% (5/171), a delayed hemorrhage rate of 1.8% (3/171), and a delayed perforation rate of 0.6% (1/171). The en bloc resection rate was 96.5% (165/171) and the complete resection rate was 93.0% (159/171). Pathological results showed 85 cases of high grade intraepithelial neoplasia (497%), 70 cases of well differentiated carcinoma (40.9%), and 16 cases of moderately differentiated carcinoma (94%). Nine patients (5.3%) received an additional surgical operation due to involvement of cancer tissues at the bottom of the focus. A total of 37 patients developed esophageal stenosis at two months after operation (21.6%). The occurrence rate of esophageal stenosis was 2.3% (2/86) for a resection range <1/2 circumference, 30.0% (15/50) for a range between 1/2 and 3/4 circumference, and 45.8% (11/24) for a range larger than 3/4 circumference, while those who underwent circumferential resection had an occurrence rate of 818% (9/11). The serious stenosis rate after operation was 11.1% (19/171). All the 19 patients received dilation treatment with an average dilation times of 1.9 (1-6), and 12 patients received stent implantation simultaneously with an average treatment times of 2.2 (1-6). Follow-ups ranged for 24-54 months (average, 40.4 months) showed 6 cases of recurrence(3.5%) which received a second endoscopic treatment. ConclusionsESD is safe and effective in the treatment of early-stage esophageal lesions. In terms of large-scale esophageal lesions, the occurrence rate of esophageal stenosis is high and repeated dilation treatment and stent implantation are often required. Regular endoscopic follow-up after operation is effective to monitor residual tumor and local recurrence.

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备注/Memo

备注/Memo:
*通讯作者，E-mail：shixg1022@sina.com①（南通大学附属海安医院消化内科，南通226600）
更新日期/Last Update: 2017-07-14