内镜黏膜下剥离食管鳞状细胞瘤变

Endoscopic submucosal dissection of esophageal squamous cell neoplasms

目的评价应用内镜黏膜下剥离术(ESD)切除食管鳞状细胞瘤变的疗效和安全性。方法对154例早期食管上皮内瘤变患者进行ESD治疗,观察病变的位置、大小、浸润深度、脉管浸润、完整切除率、治愈性切除率、并发症及随访情况。结果切除黏膜平均最大径为3.0 cm,范围1.5～6.5 cm。病变完整切除151例(92.07%),治愈性切除143例(87.20%),术中穿孔3例(1.83%),1例外科手术修补,2例内科保守治疗。纵膈积气或反应性渗出3例,保守治疗痊愈。无术中大出血及术后迟发出血。本院随访1次以上112例,电话随访30例,失访12例。随访发现病变残留2例(1.22%)。结论观察结果显示完整切除率、治愈性切除率与日本的报道结果近似,并发症发生率低于文献报道的平均水平,ESD是治疗食管浅表鳞状细胞瘤变的有效治愈性治疗手段。

Objective To evaluate the clinical efficiency and security of endoscopic submucosal dissection （ESD） in esophageal squamous cell neoplasms （ESCNs）. Methods A total of 154 patients diagnosed as early ESCNs were trea- ted by ESD. Clinical pathological factors including location, size, depth of invasion, venous invasion, entirety resection rate, curative resection rate, complication and follow-up information were assessed. Results The average maximum di- ameter of resected lesions was 3.0 cm （range 1.5 - 6.5 cm）. 151 cases were entirety resected lesions （92.07%）. 143 cases were curative resected lesions （87.20%）. Perforation was occurred in 3 cases during ESD procedures, in which 1 case was treated by surgical repair and 2 cases were recovered under conservative treatment. 3 cases occurred pneumo- mediastinum or mediastinal inflammation after ESD and recovered after conservative treatment. No bleeding was occurred during ESD procedures and thereafter. 112 cases were followed-up for more than once, in which 30 cases were followed- up by phone. 12 cases were missed following-up. 2 cases of residual lesion were found （ 1.22% ） three months after ESD procedure. Conclusion The enhloc resection and curative resection rate are similar in our study compared with Japanese reports. The complication ratio is lower compared with the average level of reports. ESD is an effective measure for ESCNs.