早期食管癌或癌前病变内镜黏膜下剥离术后再行食管切除57例

Clinical characteristics of 57 patients with early stage esophageal cancer or precancerosis treated with esophagectomy following endoscopic submucosal dissection

目的分析早期食管癌或癌前病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后再行食管切除患者的临床特点及行外科手术的原因。方法回顾性分析2012年1月至2016年10月华西医院和海吉亚医院ESD治疗的早期食管癌或癌前病变患者中因各种原因再行食管切除手术57例患者的临床资料。其中男42例、女15例,年龄65.4(52~77)岁。病变部位:胸上段15例,胸中段34例,胸下段8例。结果行食管切除手术的原因包括:3例ESD后肿瘤残留,8例经胃镜检查并活检确诊为局部复发,37例食管狭窄伴吞咽困难,9例食管直径≥1.0 cm,但有明显的吞咽困难。外科手术后病理显示16例切除食管内查见癌(包括手术前的3例残留,8例复发及新发现肿瘤复发5例),其中2例患者均有1枚淋巴结查见癌细胞。结论 ESD后食管狭窄、食管动力异常、局部残留或复发是再行外科手术的主要原因。

Objective To analyze the clinical characteristics of patients treated with esophagectomy following endoscopic submucosal dissection （ESD） for early stage esophageal cancer or precancerosis and the reasons for esophagectomy. Methods We retrospectively analyzed the clinical data of 57 patients who were treated with esophagectomy following ESD in West China Hospital and Shanxian Hygeia Hospital from January 2012 through October 2016. There were 42 males and 15 females at age of 65.4 （52-77） years. There were 15 patients of upper thoracic lesions, the middle thoracic lesions in 34 patients, and the lower thoracic lesions in 8 patients. Results The reasons for esophagectomy included 3 patients with residual tumor, 8 patients with local recurrence, 37 patients with esophageal stricture, and 9 patients with dysphagia, although the diameter was larger than 1.0 cm. The pathology after esophagectomy revealed that tumor was found in 16 patients, including 3 patients with residual tumor and 8 with recurrent tumor confirmed before esophagectomy, and 5 patients with new-found recurrent tumor. Conclusion In the treatment of early stage esophageal cancer or precancerosis, the major reasons for esophagectomy following ESD include esophageal stricture, abnormal esophageal dynamics, local residual or recurrence.