内镜黏膜下剥离术治疗早期食管癌及癌前病变44例

Endoscopic submucosal dissection for early esophageal cancer and precancerous lesions

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期食管癌及癌前病变的临床疗效及安全性评价.方法:收集2007-07/2010-06经胃镜检查、病理证实并行ESD治疗的44例早期食管癌或癌前病变患者,对其临床病理特征进行总结,并对疗效、并发症及生存率进行评估.结果:44例患者均成功地接受ESD,所有剥离标本全部得到病理确诊,基底和切缘未见病变累及.共出现出血2例,穿孔2例,食管狭窄3例.术后仅1例患者出现复发,行第2次ESD.结论:ESD治疗早期食管癌及癌前病变安全、有效,值得推广.

AIM： To explore the efficacy and safety of endoscopic submucosal dissection（ESD） for early esophageal cancer and precancerous lesions. M E T H ODS ： Forty-four patients with histologically proved early esophageal cancer or precancerous lesions who were treated by ESD at our hospital between July 2007 and June 2010 were included. The curative effectsand complications were evaluated. RESULTS： ESD was successful in all 44 cases. All lesions were resected with lateral and basal resection margins free of tumor. Massive bleeding occurred in two patients, one occurring during ESD and the other occurring 3 d after ESD. The bleeding rate was 4.5%（2/44）. Perforation occurred in two patients, both of whom recovered after several days of conservative treatment. The perforation rate was 4.5%（2/44）. Esophageal stricture occurred in two patients 2 to 4 wk after ESD. Only one case developed recurrence 3 mo after ESD and received a second ESD. Of all the 44 patients, 43 are still alive.CONCLUSION： ESD for early esophageal cancer and precancerous lesions is safe and effective.