早期下咽癌及其癌前病变内镜黏膜下剥离术治疗价值

Endoscopic submucosal dissection for early hypopharyngeal carcinoma and precancerous lesions

目的评价早期下咽癌及其癌前病变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的有效性和安全性。方法2013年8月—2019年8月,在中国医学科学院北京协和医学院肿瘤医院内镜科接受下咽部ESD治疗,经病理确诊为早期下咽癌及其癌前病变的41例病例纳入回顾性分析,主要观察手术完成率、手术用时、整块切除率、R0切除率、并发症发生情况以及复发情况。结果41例均顺利完成ESD,手术成功率为100.0%,平均用时49.1 min(10~110 min)。54处病变实施整块切除,整块切除率为98.2%(54/55),其中41处水平和垂直切缘均阴性,R0切除率为74.5%(41/55)。55处病变切除过程中均存在创面少量渗血,予热活检钳电凝成功止血。无一例发生穿孔,有2例(4.3%)术后出现迟发性出血,于急诊内镜下止血成功。术后复查内镜,1例(2.2%)出现食管入口狭窄,经多次水囊扩张后解除梗阻。随访3~72个月,中位时间18个月,1例发现下咽部同部位黏膜病变再次行ESD治疗。随访至2020年10月,未再见病变残留及复发。结论ESD治疗早期下咽癌及其癌前病变总体疗效和安全性较好,具有较好的临床应用价值。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD)for early hypopharyngeal carcinoma and precancerous lesions.Methods Clinical data of 41 patients who received ESD for early hypopharyngeal carcinoma and precancerous lesions from August 2013 to August 2019 in the Department of Endoscopy of Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively analyzed.Main outcome measurements included operation completion rate,operation time,en bloc resection rate,R0 resection rate,complication rate and recurrence.Results ESD was successfully completed in all 41 cases,with a success rate of 100.0%and a mean time of 49.1 min(ranged 10-110 min).Fifty-four lesions underwent en bloc resection,with an en bloc resection rate of 98.2%(54/55),of which 41 had negative horizontal and vertical margins,and the R0 resection rate was 74.5%(41/55).During the operation of 55 lesions,there was a small amount of blood oozing on the wound surface,and electrocoagulation with thermal biopsy forceps could successfully stop the bleeding.No perforation occurred,and 2 cases(4.3%)had delayed bleeding after ESD,and hemostasis was successful under emergency endoscopy.Postoperative endoscopy showed that 1 case(2.2%)had esophageal entrance stenosis,and the obstruction was relieved after repeated water balloon dilatation.The follow-up period ranged from 3 to 72 months,and the median time was 18 months.One case was found to have mucosal lesions in the same part of the hypopharynx and received ESD treatment again.Follow-up to October 2020,no residual lesions and recurrence were found.Conclusion ESD is a safe and effective option for the treatment of early hypopharyngeal carcinoma and precancerous lesions,which is worthy of clinical application.