食管上皮高度不典型增生的处理

Management of esophageal mucosa with high-grade dysplasia

背景与目的：改善食管癌患者预后的最有效方法是早期诊断、早期治疗。食管上皮高度不典型增生患者可能存在早期癌变，处理方法存在争议。本研究探讨对内镜活检病理诊断为食管上皮高度不典型增生患者的处理。方法：对我院1999-2006年间10例术前内镜活检病理诊断为食管上皮高度不典型增生患者的术式、手术后并发症和疗效的分析，结合文献报道食管上皮高度不典型增生的处理方法，以探讨内镜活检病理诊断为食管上皮高度不典型增生病例的合适的处理措施。结果：10例内镜活检病理诊断为食管上皮高度不典型增生的患者经食管切除术后，病理证实原位癌2例（20％），浸润性癌8例（80％），区域淋巴结转移率为零，手术后30d内死亡率为零，围手术期颈部吻合口漏1例，经处理后2周漏口愈合。1例术后因非肿瘤疾患死亡，其余患者均长期无瘤生存（术后存活时间3～66个月）。结论：根据我们的临床资料，结合文献报道，认为大部分食管上皮高度不典型增生患者已经存在原位癌或浸润性癌，且相当部分高度不典型增生患者会转变成浸润性癌。外科切除食管目前是胸外科较成型术式，手术风险小，术后患者预后好，是食管内镜活检病理诊断为高度不典型增生患者的合适的治疗方法。

Background and purpose： Early detection is still the most effective way to improve the prognosis of patients with esophageal cancer. Patients with hlgh-grade dysplasia of esophageal mucosa might be considered as the sign of early carcinogenesis, but the management of the disease is controversial. The purpose of the present study was to explore the management of esophageal mucosa with high-grade dysplasia. Methods： 10 patients with high-grade dysplasia in esophageal mucosa as original diagnoses who received esophagectomy in Cancer Hospital of Fudan University from 1999 to 2006 were included in this study, The surgical approach, operative mortality, in-hospital complications, pathologleal results and survival of the patients were analyzed. Based on our data along with other literatures, our aim was to find the appropriate management for patients with high-grade dysplasia. Results： 10 cases were diagnosed as high-grade dysplasia in esophageal mucosa through endoscopic biopsy and proved to be esophageal carcinoma after esophagectomy. 2 of them （20%） was localized carcinoma, 8 （80%） cases were invasive cancer with no regional lymph nodes involved. 30-day mortality rate was 0. One patient experienced cervical anastomosis leakage, but he recovered in 2 weeks after proper treatment. There was no pulmonary complication. Conclusions： Most patients with high-grade dysplasia in esophageal mucosa actually have occult carcinoma. Most of the patients with high-grade dysplasia in esophageal mucosa would develop cancer during their lifetime. Esophagectomy is now a common surgical approach as appropriate treatment of the patients with high-grade dysplasia in esophageal mucosa.