内镜黏膜切除术治疗上消化道早期癌和癌前病变

Treatment of early gastroesophageal cancer and precancerous lesion with endoscopic mucosal resection

目的探讨内镜黏膜切除术(EMR)治疗上消化道肿瘤的应用价值。方法回顾性分析108例(126个病灶)内镜下行EMR治疗资料。结果 126个病灶中,直接用圈套器切除86个病灶,用透明帽切除40个病灶。病灶大小0.3cm×0.4cm～5.0cm×7.0cm,均为扁平病灶;92个病灶1次切除,34个病灶多次(>2次)分割切除;102个病灶取到病理组织,24个病灶未取到;完全切除118个,完全切除率93.7%。内镜分型:隆起型(Ⅰ型)64个,其中亚蒂型(Isp)45个,无蒂型(Is)19个;平坦型(Ⅱ型)62个,其中平坦隆起型(Ⅱa)34个,平坦隆起+平坦凹陷型(Ⅱa+Ⅱc)10个,表面平坦型(Ⅱb)18个。组织学分型早期癌4个,重度不典型增生14个,中度不典型增生59个,单纯腺瘤26个,非腺瘤性息肉23个。其中发生大出血1例,有18例切除后出现少量渗血,无一例穿孔。结论内镜下黏膜切除术简单、安全。

Objective To discuss the clinical value of endoscopic mucosal resection（EMR） in trating early gastroesophageal cancer and precancerous lesion.Methods Data of 126 lesion with EMR in 108 patients were analyzed.The lesions were confirmed histologically after operation.Results Of 126 EMR lesions,86 procedures were performed by snare resection techniques and 40 by suction cap assisted.Complete resection rate was 93.7%（118 of 126）.The diameters of the lesions were from 0.3 cm×0.4 cm to 5.0 cm×7.0 cm.Lesion typing by endoscopy was type Ⅰ in 64 lesions（type Isp in 45 lesions,type Is 19 in lesions）,type Ⅱ in 62 lesions（typeⅡa in 34 lesions,typeⅡa＋Ⅱc in 10 lesions,typeⅡb in 18 lesions）.Histopathologic diagnosis was carcinoma in 4 lesions,HGD in 14 lesions,MGD in 59 lesions,adenoma in 26 lesions,non-adenoma in 23 lesions.There was no perforation case.Bleeding occurred in 19 lesions,which were all cured.Conclusion Endoscopic mucosal resection is simple and safe for early gastroesophageal cancer and precancerous lesion.