早期食管癌及癌前病变多环黏膜切除60例报告

Multi-band Mucosectomy for Early-stage Esophageal Carcinoma and Precancerous Lesions: Report of 60 Cases

目的：探讨多环黏膜切除术（ multi-band mucosectomy ， MBM ）治疗早期食管癌及癌前病变的疗效和安全性。方法我院2011年12月～2013年10月对60例胃镜及病理确定的早期食管癌及癌前病变，胃镜下1．2％卢戈液染色，确定病灶并标记切除范围，安装多环黏膜切除器，自口侧将病灶上缘及标记点上皮层吸入，释放橡胶环完成套扎，圈套器电凝切除，收集组织标本；重复吸引、套扎、切除至病灶完全切除。结果60例共84处病灶，1例术中出血转胸外科手术，其余59例83处（98．3％）病灶均一次性成功切除。使用皮圈1～12发，共用皮圈289发，平均4．8发／例。手术时间10～60 min，平均23．5 min；切除长度1．0～10 cm，宽度不超过3／4食管周径；3例（5．0％）术中明显出血，2例术中止血，1例转外科手术，术后无一例出血。术中穿孔1例（1．7％），置入全覆膜金属支架保守治疗成功。术后病理：全部标本基底无癌残留，原位癌9例，高级别瘤变29例，低级别瘤变12例，角化不全6例，颗粒细胞瘤1例，息肉／炎性增生3例。59例随访1～23个月，2例（3.4％）食管狭窄，经探条扩张吞咽困难缓解，无一例局部复发及发现淋巴结转移。结论 MBM治疗早期食管癌及癌前病变近期疗效确切，安全可靠；技术要求相对较低，值得广泛推广。

Objective To study the efficacy and safety of multi-band mucosectomy （MBM） for the treatment of early-stage esophageal carcinoma and precancerous lesions . Methods A total of 60 cases of early-stage esophageal carcinoma and precancerous lesions （ diagnosed pathologically ） were admitted from December 2011 to October 2013 in this hospital .The scope of lesion was determined by using 1.2% Lugo staining and the target area was delineated with coagulation marking .After the installation of polycyclic mucosal resection device , the mucosa was sucked into the cap , a rubber band was released , pseudopolyps were removed with the hexagonal snare , and tissue samples were collected .The above mentioned procedures were repeated until the complete removal of the lesion. Results There were a total of 84 lesions in the 60 cases.Except a conversion to thoracic surgery was conducted in 1 case because of bleeding , the remaining 83 lesions in 59 cases （98.3%） were successfully removed at one-time.The operation used a total of 289 hair aprons, with 1-12 rounds in each case （mean, 4.8 rounds/case）.The operation time was 10-60 minutes （mean, 23.5 minutes）.The resection was 1.0-10 cm in length and 〈3/4 esophageal circumference in width .Intraoperative massive hemorrhage occurred in 3 cases （5.0%）, 2 of which were given intraoperative hemostasis and 1 of which underwent conversion to open surgery . No postoperative hemorrhage happened .Intraoperative perforation was found in 1 case （1.7%）, which was cured by using all-covered metal stent implantation for conservative treatment .Postoperative pathological outcomes showed no residual cancer in basal part in all specimens , and 9 cases of carcinoma in situ , 29 cases of high-grade neoplasia , 12 cases of low-grade neoplasia , 6 cases of parakeratosis , 1 case of granular cell tumor , and 3 cases of polyp/inflammatory hyperplasia .Follow-up examinations in 59 cases for 1-23 months showed 2 cases （3.4%） of esophageal stenosis, which were relieved after bougienage .No local recurrence or lymph node metastases was found . Conclusion MBM treatment for early-stage esophageal cancer and precancerous lesions is safe , effective, and reliable, being worthy of wide promotion .