内镜下黏膜剥离术治疗早期食管癌及癌前病变的疗效评价

目的观察基层医院采用内镜下黏膜剥离术(ESD)治疗早期食管癌及癌前病变的安全性、可行性及有效性分析。方法回顾性分析2013年1月至2016年12月接受ESD术的56例早期食管癌及癌前病变的患者,评价了切除病灶大小、癌变位置、术后病理类型、手术时间以及术后并发症。结果56例患者中,采用ESD治疗早期食管癌及癌前病变整块切除率为91.07%,R0切除率为83.93%,RI切除率为16.07%,而术后随访复发率为3.57%,围手术期2例发生穿孔,予钛夹闭合及禁食等保守治疗后好转;2例出现术后迟发性出血,内科药物保守治疗后出血停止;8例出现术后食管狭窄,根据狭窄程度给予不同次数球囊扩张后食管狭窄症状均有所好转,术后随访期间未发现食管癌相关死亡病例。结论在基层有条件的医院开展ESD治疗早期食管癌及癌前病变,是一种安全、有效、可行的方法。

Objective To observe the safety,feasibility and clinical eficacy of endoscopid submucosal dissection(ESD)for early esophageal cancer and precancerous lesions in primary hospital.Methods 56 patients who suffered from early esophageal and precancerous lesions were retrospectively analyzed and received ESD in the Wenzhou centre hospital from January 2013 to December 2016.The specimen size,location,histopathology type,procedure time and postoperative complications were evaluated.Results Among 56 patients,ESD as the preferred option in the treatment of early esophageal cancer and precancerous lesions with complete resection rates of 91.07%,with R0 rates of 83.93%and RI rates of 16.07%,and a low rate recurrence of 3.57%.2 patients were observed perioperative perforation which were cured by endoscopic titanium clip combined with nesteia 2 patients experienced postoperative delayed hemorrhage were treatment for conservative medicine and 8 patients showed postoperative esophageal stricture that received multiple ballon dilatations and got better than before,no patient died of esophageal cancer during follow-up.Conclusion ESD is a safe,feasible and efective approach in treatment of early esophageal cancer and prec ancerous lesions in the primary qualified hospital.