内镜下射频消融术联合内镜黏膜切除术治疗大面积非表浅平坦型早期食管鳞状细胞癌和癌前病变疗效初探

Preliminary study on efficacy of radiofrequency ablation combined with endoscopic resection for ;eradicating widespread early non-flat type esophageal squamous cell carcinoma

目的：探讨内镜下联合应用射频消融系统（RFA）和内镜下黏膜切除术治疗范围广泛的非表浅平坦型早期食管鳞状细胞癌及癌前病变的治疗效果。方法北京协和医学院中国医学科学院肿瘤医院内镜科于2010年1月对经活检病理确诊的2例鳞状细胞癌、1例鳞状上皮中度不典型增生（MGIN）和1例鳞状上皮重度不典型增生（HGIN）患者予以内镜下RFA术联合内镜黏膜切除术治疗，总结分析术中、术后和随访情况。结果4例患者均顺利完成治疗，其中RFA时间为3～12（8．3） min，内镜下黏膜切除术时间6～20（10．3） min；所有病例均无出血和穿孔的发生。2例鳞状细胞癌患者病变长度分别为12和8 cm，非表浅平坦性病变长度分别为3和4 cm；MGIN患者的病变长度6 cm ，非表浅平坦性病变长度2 cm；HGIN患者的病变长度12 cm ，非表浅平坦型病变长度1 cm；术后病理与术前活检病理一致。4例术后均出现狭窄，其中2例为轻度狭窄，未予处理；2例为重度狭窄，行内镜下水囊扩张术均缓解。平均住院时间3d。3例经过3月及1年以上随访，治疗区域活检病理均达到完全缓解；余1例术后3月复查可见散在的碘染色阳性灶，活检病理为HGIN，分别追加RFA治疗后达到完全缓解。结论 RFA联合内镜下黏膜切除术治疗大面积非表浅平坦型早期食管鳞状细胞癌和癌前病变是安全有效的。

Objective To evaluate the efficacy of radiofrequency ablation （RFA） combined with endoscopic resection （ER） for eradicating widespread early non-flat type esophageal squamous cell carcinoma （ESCC） and precancerous lesions. Methods Retrospective analysis was performed on the clinical data of 4 patients with early non-flat type ESCC and precancerous lesions in January 2010 at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences. Proportion of patients with histological complete response （CR） 3 months, 12 months to 5 years after operation and adverse events were observed. Results These 4 patients were all male, aged from 47 to 71 （mean age 62） years, including 2 of ESCC, 1 of HGIN, 1 of MGIN confirmed by pathology. USL length was 6-12 （mean＂8.5） cm. Treatment area （TA） length was 8-14 （mean 10.5） cm. Three cases were 0-Ⅱa（mean length 2 cm）, and 1 case 0-Ⅱc （mean length 4 cm）. Lesions of 2 cases were complete cycle, and other 2 cases occupied 3/4 circumference. Four patients completed their operations successfully. Total operation time was 42-105 （mean 66.8） min, RFA time was 3-12 （mean 8.25） min, and ER time was 6-20 （10.25） min, without bleeding and perforation. The mean hospital stay was 3 days. Pathology examination showed that 2 cases were ESCC G2（lesion length 12, 8 cm; non-flat type lesion length 3, 4 cm）, 1 was HGIN （lesion length 12 cm; non-flat type lesion length 1 cm） and 1 was MGIN （lesion length 6 cm; non-flat type lesion length 2 cm）. Three cases were CR 3 months, 1 to 5 years after operation. One case had HGIN at 3-month and MGIN at 1-year and 3-year during follow up , and was CR after treatment with HALO. Postoperative esophageal stenosis occurred in 4 cases. Among them , 2 cases were mild without treatment, and 2 were severe, who were relieved by endoscopic water sac dilation for 5-8 （mean 6.5） times. Conclusion RFA combined with ER is effective and safe in the treatment of patients with early non-flat esophageal squamous cell carcinoma and precancerous lesions.