内镜黏膜切除术治疗早期食管癌及其癌前病变

Endoscopic Mucosal Resection for Early Esophageal Cancer and Its Precancerous Lesion

目的:探讨透明帽法食管黏膜切除术治疗早期食管癌及食管癌前病变的意义。方法:在内镜下应用透明帽法对4例早期食管癌、11例食管鳞状上皮重度不典型增生和1例中度不典型增生行食管黏膜切除。应用氩离子凝固术(APC)治疗残留及复发病灶。结果:应用透明帽法共对16例患者进行局部黏膜切除,共切除病灶20块。本组术后出血3例,其中动脉出血1例,渗血2例。应用肾上腺素盐水注射及氩离子凝固术治疗均成功止血;无1例食管穿孔发生。11例患者的食管黏膜病变被完全切除,其余病例有不同程度的残留,应用氩离子凝固术治疗残留病变。术后4个月复查内镜,病理证实3例重度不典型增生局部复发。结论:应用透明帽法食管黏膜切除术可简便、安全、有效地治愈早期食管癌及癌前病变,有较好的应用前景。

Objective： To explore the effect of endoscopic esophageal mucosal resection using transparent cap-fitted endoscope to treat early esophageal cancer and precancerous lesion of esophageal cancer. Methods ： Endoscopic esophageal mucosal resection was performed with transparent-cap technique on 4 cases of early esophageal cancer and 11 cases of severe dysplasia and 1 case of medium dysplasia, and the residual lesions were treated by argon plasma coagulation （APC）. Results： Local esophageal mueosa was reseeted in 16 cases , with 20 lesions, using transparent cap-fitted endoscope. After the mucosectomy, 3 cases had bleeding which was controlled successfully by local injection of saline-epinephrine and APC. None suffered from perforation. The lesions of 11 eases were completely resected and the remaining cases had residual lesions that were treated by APC. Three cases of severe dysplasia were discovered recurrent endoscopically 4 months after resection and were cured by APC. Conclusion： Safe, simple, minimally invasive and effective on early esophageal eancer and precancerous lesion, endoscopic mucosal resection （EMR） is promising clinically.