食管癌高发现场早诊早治 30年临床研究经验

30- year Experiences on Early Detection and Treatment of Esophageal Cancer in High Risk Areas

笔者在食管癌高发地区开展食管癌早诊早治的临床研究逾 30年。通过对 22 285人的内镜检查，发现 742例早期食管癌。早期食管癌内镜下食管粘膜改变可归纳为 3种类型。（ 1）粘膜颜色改变：分红区和白区；（ 2）粘膜增厚和血管结构改变；（ 3）粘膜形态改变：糜烂、斑块、粗糙和结节。采用内镜下食管粘膜碘染色技术，可早期发现食管癌和癌前病变。对 307例早期食管癌采用食管切除手术治疗 [包括原位癌 65例、粘膜内癌 95例和粘膜下浸润癌 147例，原位癌未发现淋巴结转移，而粘膜内癌中 2例 (2.11％ )、粘膜下浸润癌中 27例 (18.37％ )已有淋巴结转移 ]。术后随诊 24年，随诊率 95％，结果发现 5年生存率为 84.1％， 10年生存率为 72.9％。对 141例采用内镜粘膜切除术，其中 22例随诊满 5年，其 5年生存率为 100％。现场临床研究发现，重度和部分中度不典型增生者是癌前病变，如能重点治疗这一群体，则能有效切断目标人群癌变风险的主要来源，可使食管癌的发病率下降 2/3。

The author had conducted the clinical study on early diagnosis and early therapy of esophageal cancer（ EC） in the area of high prevalence for more than 30 years. In the endoscopic survey, 742 patients were diagnosed as early EC from 22 285 participants. The endoscopic appearance of the mucosa in early EC was classified into three types:(1) change of mucosa color: red and white area; (2) Increased thickness and change of the vascular pattern of the mucosa;(3) mucosa morphology: erosion, plaque, coarseness and nodular. Iodine staining under endoscopic examination had promoted the early detection of EC and precancerous lesions. Since 307 patients with EC at early stage (65 carcinoma in situ, 95 intramucosal carcinoma, and 147 submucosal carcinoma) had undergone esophagectomy. There were no lymphatic metastasises in carcinoma in situ, however there were 2 cases (2.11％ ) of intramucosal carcinoma and 27 cases (18.37％ ) of submucosal carcinoma with lymph node metastasis. 24- year follow- up, results showed that 5- year survival rate is 84.1％ and a 10- year survival rate is 72.9％ among the cases of esophagectomy. A 5- year survival rate is 100％ in 22 cases followed up for full five years among 141 cases with endoscopic mucosectomy. According to this study, severe dysplasia and some moderate dysplasia were precancerous lesions. Should these precancerous cases be treated, the cancerization risk of target population would reduce dramatically and the incidence of EC would be decreased down to 2/3. Keyword esophageal cancer; early detection and treatment; endoscopy;iodine staining; endoscopic mucosectomy; precancerous lesion