内镜下黏膜切除术治疗早期食管癌和癌前病变长期生存率观察

Long-term survival rate of precancerous lesions and early esophageal cancers after endoscopic mucosal

目的观察内镜下黏膜切除术（EMR）治疗早期食管癌和癌前病变的长期生存率。方法随访前期154例经EMR治疗的早期食管癌和癌前病变的患者，分别于术后1个月、6个月和12个月进行内镜复查，如发现有可疑局部复发，则立即进行氩离子凝固术（APC）治疗。术后1年后，每年随访1次，随诊率100％。结果术后5年内发现病变复发6例，复发率为3．9％（6／154），其中4例接受食管切除手术治疗，1例采用APC治疗，另1例因复发癌转移死亡。本组共发生4例死亡，包括1例因复发癌转移死亡和3例非癌死亡，5年生存率为97．4％（150／154）。其中重度异型增生、原位癌和黏膜内癌共125例，发生2例非癌死亡和1例复发癌转移死亡，5年生存率为97．6％（122／125）；中度异型增生29例，发生1例非癌死亡，5年生存率为96．6％（28／29）。结论EMR适合于早期食管癌和癌前病变的治疗，特别是重度异型增生、原位癌和黏膜内癌，其创伤小、痛苦少，几乎无后遗症，有很好的长期生存效果。

Objective To evaluate the long-term survival rate of precancerous lesions and early esophageal cancer after endoscopic mueosal resection （EMR）. Methods The follow-up endoscopy was performed in 154 patients with early esophageal cancer and precancerous lesions who underwent EMR. The examinations were carried out at 1 month, 6 months and every 1 year after the procedure, respectively, and argon plasma coagulation （APC） was applied if a recurrent lesion was suspected. The follow-up rate was 100%. Results After EMR, reccurencc occurred in 6 cases （3.9%） in 5 years, of which 4 received esophagectmy, 1 underwent APC, and the other one died from matastasis. The 5-year survival rate was 97.4% （150/154） , with 1 died from malastasis and 3 from noncancerous diseases. The 5-year survival rate of 125 patients with high grade dysplasia, carcinoma in situ and intramueosal carcinoma was 97.6% （ 122/ 125）, with 1 died from noncancerous disease and 1 from metastasis. The 5-year survival rate of 29 patients with low grade dysplasia was 96.6% （28/29） with 1 patient died from noncancerous disease. Conclusion EMR, as a minimally invasive procedure, is suitable for precancerous lesions and early esophageal cancer, especially for high grade dysplasia, carcinoma in situ and intramucosal carcinoma, with little sequela and long-term survival.