消化道肿瘤的早期诊断与内镜下微创治疗

Early Diagnosis And Endoscopic Minimally Invasive Treatment of Gastrointestinal Tumor

消化道肿瘤是我国常见的严重威胁患者生命健康的疾病,随着医疗技术的发展,越来越多的消化道肿瘤被早期发现。消化内镜在其早期诊断与治疗中占据着举足轻重地地位。近年来,一些新型辅助内镜,如超声内镜、放大内镜、电子染色内镜、共聚焦激光显微内镜等已用于早期食管、胃肠肿瘤的辅助诊断,使得我们对早期消化道肿瘤的内镜下表现有了一个全新的认识。此外,多种内镜下微创治疗新技术如内镜黏膜下剥离术(ESD),经内镜黏膜下隧道剥离术(ESTD),经内镜黏膜下隧道切除术(STER)等也逐渐应用于临床。这些新技术在减少组织损伤的同时取得了十分显著的临床疗效,但在早期消化道肿瘤的诊治方面仍面临一些新问题,如怎样准确判断病变深度、评估淋巴结转移风险、避免或减少术后并发症的发生、术后病理学分型及标本切缘处理的规范等,要解决这些问题需消化科医师、内镜临床医师及病理科医师等共同努力。随着基础医学的发展,一些新型的小分子物质(Micro-RNA)已被证实与肿瘤的发生发展密切相关,其表达水平与肿瘤分期、临床疗效及预后相关,或许在未来能协助我们早期诊断消化道肿瘤。总之,只有结合内镜、影像学及病理学等多种检查措施,积极开展消化内镜新技术,消化道肿瘤才能更早期地获得诊断和治疗,从而改善患者的生存和预后。

Gastrointestinal tumor could be aggressive and life threaten if it was not be diagnosed and treated at early stage. Digestive endoscopy plays a very important role in the early diagnosis and treatment of gastrointestinal tumor,and shows rapid evolution with novel technologies in the past years,such as endoscopic ultrasonography,magnifying endoscopy,electronic staining endoscopy,endoscopic confocal laser microscopy.Nowaday it becomes feasible to learn more about the endoscopic manifestation in early stage GI tumor.Besides,several new endoscopic surgical techniques,such as endoscopic submucosal dissection（ESD）,endoscopicsubmucosal tunnel dissection（ESTD）,submucosal tunneling endoscopic resection（STER）,has been applied in clinical treatment of early stage GI tumor with curative effect.However,there are some new problems emerged,such as how to determine the depth of the lesion,how to avoid or reduce the incidence of postoperative complications,and how to standardize the pathological classification and the treatment of positive margin,which need multidisciplinary solution with the efforts from endoscopist,clinician and pathologist. With the deep insight on, molecular pathogenesis of GI tumor,new technologies combinding endoscopy,imaging and pathological measures,will promote more GI tumor early diagnosed and effectively treated,thus improve the survival and prognosis of GI tumor patients.