应用内镜黏膜下剥离术处理食管黏膜病变疗效评价

Evaluation of endoscopic submucosal dissection for early esophageal cancers and precancerous lesion

目的应用内镜黏膜下剥离术(ESD)处理食管早癌及癌前病变,评价其疗效和安全性。方法回顾性分析2008年10月至2009年10月分别于复旦大学附属中山医院和新疆医科大学第六附属医院内镜检查及病理诊断为早期食管癌及癌前病变35例患者,其中男性24例,女性11例;年龄38～78岁,平均年龄60岁。对患者行内镜下治疗,观察术中出血、穿孔及术后食管狭窄的发生情况,统计病灶完整大块切除率与组织学完全切除率,通过随访评价复发或转移情况,对内镜治疗短期效果进行初步评价。结果完成ESD操作28例,7例(20.0%)改为内镜下黏膜切除术(EMR)切除,手术耗时20～125min,平均耗时65 min。颈部气肿1例,术中穿孔2例(5.7%),术中少量出血8例(22.9%),术后延迟性出血1例。组织学治愈26例(74.3%)。除2例手术治疗外,32例完成随访,1例(3.3%)失访。随访4～26个月,中位随访时间10个月。随访中,3例复发,复发率9.4%(3/32),3例发生术后食管狭窄包括1例复发病例。结论 ESD治疗早期食管癌及癌前病变具有较好的疗效和安全性。

Objective To evaluate the effectiveness and safty of endoscopic submucosal dissection（ESD） in early esophageal cancers and precancerous lesion.Methods A total of 35 patients with precancerous lesions and early stage esophageal cancer accepted endocopic treatment from October 2008 to October 2009 were enrolled,male 24,female 11,aged 38-78 years old,mean age 60 years old.The operative bleeding,perforation and postoperative esophageal stenosis were observed,and the complete lesion resection rate and histological complete resection rate were statisticed.The recurrence or metastasis was evaluated with follow-up and the short-term effect of endoscopic treatment was preliminary evulated as well.Results The 28 patients were performed ESD and the other 7 patients were endoscopic mucosal resection（EMR）.Average procedure time was 65-minute（20-125 minutes）.Cervical emphysema occurred in 1 patient and was treated conservatively,2 cases of perforation（5.7 %） and 1 delayed bleeding were encountered during ESD and clamped by metal clips,8 cases occurred minor bleeding during ESD procedure（22.9 %） and 1 case occurred delayed operative bleeding.Histological cure were 26 cases（74.3 %）.Two cases performed operations,and 32 cases completed follow-up,1 case lost（22.9 %）.The follow-up time was 4-26 months,median time 10-month,3 cases recurred（3/32,9.4 %）,and postoperative stricture occurred in 3 cases included 1 recurrence case.Conclusion It is demonstrated that ESD is a safe and effective treatment for early esophageal cancer and precancerous lesions.