内镜黏膜下剥离术治疗近环周早期食管癌及癌前病变的价值

Value of endoscopic submucosal dissection in treatment of early esophageal cancer and precancerous lesions within near-circumferential section

目的探讨内镜黏膜下剥离术（endoscopicsubmucosaldissection，ESD）治疗食管环周3／4以上的近环周早期食管癌和癌前病变的临床应用价值。方法回顾分析内镜下行ESD治疗的26例食管环周3／4以上的近环周早期食管癌和癌前病变患者的内镜、病理及随访资料。结果全部病例一次性完整切除，ESD剥离病变成功率100％（26／26）；ESD手术时间75—140rain，平均95min；术后未发生出血、穿孔、严重感染等并发症；所有剥离病变经病理进一步确诊，基底和切缘未见明显病变累及；术后随访3～43（平均15．6个月）个月，创面完全愈合，仅1例病变复发；术后食管狭窄率50％，经扩张后随访，狭窄均得以临床治愈。结论对食管环周3／4以上的近环周早期食管癌和癌前病变仍然可以行ESD治疗，且操作安全，创伤少，术后食管狭窄通过扩张后仍然能够达到临床治愈的目的，避免了外科手术的巨大创伤，是ESD在治疗近环周早期食管癌和癌前病变的一种新的尝试。

Objective To discuss the clinical application value of the treatment of early esophageal cancer and precancerous lesions within the near-circumferential （ more than three-quarter of the circumferential） section using endoscopic submucosal dissection （ESD）. Methods Retrospective analysis of the endoscopy, pathology and follow-up was performed in 26 patients with early esophageal cancer and precancerous lesions within the near-circumferential undergone with ESD. Results The lesions in all patients were completely resected, and the complete resection rate was 100%. The time of ESD was about 75 to 140 rain, with an average of 95 min. Complications such as bleeding, perforation and severe infection were not occurred after ESD. All of these dissected lesions were confirmed by pathology, and there was no lesion in basement and incisal margin. During the follow-up of 3 to 43 months （ mean 15.6 months）, the surface of wound was completely closed up, with only one case of recurrence. The rate of esophageal stenosis was approximately 50% after ESD and the stenosis could be clinically cured through endoscopic balloon dilation. Conclusion ESD is still a suitable and safe method with small damage for resection of early esophageal cancer and precancerous lesions within the near-circumferential （ more than three-quarter of the circumferential） section. The esophageal stenosis can be clinically cured through endoscopic balloon dilation after ESD. These results provide a novel trial for treatment of early esophageal cancer and precancerous lesions within the near-circumferential section, avoiding the tremendous trauma of surgical operation.