内镜下应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的临床研究

Clinical application of endoscopic Argon Plasma Coagulation on early esophageal cancer and precan cerous lesion

目的 探讨应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的意义。方法1999年10月2003年1月内镜下应用氩离子血浆凝固术对13例早期食管癌及114例食管鳞状上皮异型增生进行治疗,氩离子血浆凝固术功率设定为28 W,氩气流量0.4 L／min。术后1个月、4个月及12个月进行内镜复查及治疗。结果 (1)氩离子血浆凝固术治疗早期食管癌及食管癌前病变的成功率分别为92.3％和100％,平均治疗次数分别为3次和2.2次。(2)本组127例合并症发生率为5.5％,其中早期癌与癌前病变合并症的发生率分别为30.7％和2.60％,合并症主要表现为出血、黏膜下血肿及发热等,经对症治疗后均治愈。本组无穿孔及狭窄发生。(3)4-12个月内镜复查并经病理证实3例早期癌复发,再次应用氩离子血浆凝固术治疗,2例治愈,1例病变未控改为手术治疗。癌前病变无复发。(4)本组术后平均随访时间为15.3个月,所有患者目前均无明显不适。结论 应用氩离子血浆凝固术可简便、安全、有效地治疗早期食管癌及癌前病变,具有较好的应用前景。

Objective To study on the effectiveness of endoscopic Argon Plasma Coagulation (APC) in treating early esophageal cancer or precancerous lesion. Methods From Oct 1999 to Jan 2003 Argon Plasma Cocagulation was performed on 114 cases of precancerous lesion and 13 cases of early esophageal cancer. A 28 W (lower power) and 0. 4 L/min APC setting was used to deliver therapy. All patients were followed up by endoscopic examinations a( 1 , 4 and 12 months after the therapy. Results (1)The success rates in early esophageal cancer and precancerous lesion group were 92. 3% and 100% with sessions of 3 and 2. 2 in average respectively. (2) Complication rate is 30. 7% and 2. 6% respectively in early esophageal cancer and precancerous lesion group. The major complications are asymptomatic bleeding, fever and submucosal haematoma. All of the complications were successfully controlled by compression and local spray of saline-epinephrine. Neither perforation nor stricture had occurred in these patients. (3)Three cases of early cancer recurrence from 4 months to 12 months after APC treatment were treated by APC again, two cases were cured, and the other one received esophagoctomy because of the recurrence of local lesion . (4) Ail cases survived without obvious discomfort after a follow up of 15. 3 months on average, the long term results to be studied on further follow up. Conclusion Endoscopic Argon Plasma Coagulation ( APC) is a promising clinical therapeutic measure showing the advantages of safety, simplicity, effectiveness and minimal invasion in cases with early esophageal cancer and precancerous lesion.