新型多环黏膜套切术治疗食管早癌和上皮内瘤变的疗效和安全性分析

The efficacy and safety analysis for endoscopic multi-band mucosectomy in the treatment of early esophageal cancer and intraepithelial neoplasia

目的 探讨内镜下新型多环黏膜套切术（EMBM）治疗食管早癌和上皮内瘤变的疗效和安全性.方法 回顾性分析EMBM治疗34例食管早癌和上皮内瘤变患者临床资料,总结其治疗效果及安全性.结果 34例共36处病灶均一次性顺利完成EMBM.术后病理证实高级别上皮内瘤变24处、低级别上皮内瘤变4处、黏膜内癌6处、黏膜下浅层癌1处、黏膜下深层癌1处.术中出血2例,予电凝止血,术后无迟发出血、皮下气肿及食管穿孔发生.食管狭窄2例,予探条扩张后吞咽困难缓解.1例黏膜下深层癌基底见淋巴管浸润,转胸外科手术治疗.其余33例内镜随访6 ～ 24个月,无一处病灶局部复发和转移.结论 EMBM治疗食管早癌和上皮内瘤变操作简单、安全、疗效显著,值得推广.

Objective To investigate the safety and efficacy of endoscopic multi-band mucosectomy （EMBM） in the treatment of early esophageal cancer and intraepithelial neoplasia.Methods A retrospective analysis was made on the clinical data of 34 cases diagnosed with early esophageal cancer and intraepithelial neoplasia.All the patients accepted EMBM.The therapeutic effects and safety were summarized.Results A total of 34 patients with 36 lesions were successfully completed in the treatment of one session.The entire biopsy specimen was tested by pathological examination.High-grade intraepithelial neoplasia in 24 lesions,low-grade intraepithelial neoplasia in 4 lesions,intramucosal cancer in 6 lesions,a submucosal shallow cancer and a submucosal deep cancer were diagnosed.Clamps electric coagulation hemostasis was used during the operation in 2 bleeding cases.No delayed postoperative bleeding,subcutaneous emphysema and esophageal perforation happened.Two cases appeared esophageal stenosis after EMBM.Bougienage were used to relieve dysphagia.One case confirmed with deep submucosal lymphovascular invasion accepted surgery later in department of thoracic surgery.No local recurrence and metastasis were found in the other 33 cases during the 6-24 months of follow-up time.Conclusions EMBM is a minimally invasive,safe and effective method for the treatment of early esophageal cancer and intraepithelial neoplasia.EMBM is worthy of promotion.