新型多环黏膜切除器在食管内镜下手术的初步应用

Endoscopic resection using the new duette multiband mucosectomy kit for esophageal disease

背景与目的：食管内镜治疗近年来发展迅速，本研究旨在探讨新型多环黏膜切除器DT-6在食管内镜下切除术（endoscopic resection，ER）的应用价值。方法：2011年6月至今，复旦大学附属肿瘤医院胸外科使用DT-6多环黏膜切除器完成了100例食管内镜下切除术。选取已有6个月以上随访期的患者为研究对象，对手术参数、围手术和术后随访情况作总结和分析，并比较食管切除术和内镜治疗在治疗食管癌前病变或早期癌的围手术参数。结果：2011年6月-2012年1月，共有32例患者在复旦大学附属肿瘤医院胸外科接受食管内镜下切除术，术中均使用新型DT一6。32ff0患者中，男性22例，女性10例，平均年龄59．0岁（25～83岁）。共进行了34次内镜下切除术，包括31例内镜下黏膜切除（endoscopic mucosal resection，EMR）和3例内镜黏膜下病变剥离术（endoscopic submucosal dissection，ESD），平均每次手术切取标本数为（3．4±1．0）块，标本平均直径为（11．8±2．7）mm，术中出血量为（5．45±1．47）mL。术后中位随访时间8．3个月，无一例出现出血、穿孔或食管狭窄。食管癌前病变和早期癌行食管内镜下切除术相比食管切除术在手术用时、出血量、住院时间和并发症方面差异均有统计学意义（P〈O．05）。结论：新型多环黏膜切除器行食管内镜下切除术具有简便、安全、有效的优势，值得进一步推广。内镜手术与食管切除术对早期食管癌（h之前）和高级别上皮内瘤变的远期治疗效果是否等同，还需要经过长期的临床随访。

Background and purpose： Endoscopic treatment is a promising therapeutic option for superficial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection （ER） using the new Duette multiband mucosectomy kit （DT-6） on treating esophageal disease. Methods： Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia （HGD） lesions and early esophageal cancer. Results： From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 （22 male and 10 female, mean age 59.0 years, range 25 to 83 years）. There were （3.4±1.0） specimen resected per operation, and the average greatest diameter was （11.8＋2.7）mm. Intraoperative blood loss was （5.45＋1.47）mL. The median follow-up period was 8.2 months with a 100% half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection （ESD）, no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion： ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to comoare endosconic resection and compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.