同时ESD治疗食管和胃双原发早期癌及癌前病变有效性的分析

Efficacy and prognostic analysis of endoscopic submucosal dissection for simultaneous treatment of double primary early carcinoma and precancerous lesions of esophagus and stomach

目的 探究内镜黏膜下剥离术(ESD)同时治疗食管和胃双原发早期癌及癌前病变的可行性、安全性、有效性及预后。方法 回顾性分析了湖北医药学院附属太和医院2014年1月1日至2020年10月1日食管和胃行ESD治疗的所有患者的临床资料。共随访3~24个月。结果 5例患者中男4例,女1例。年龄64~71岁;平均年龄67岁。1例有高血压病史,1例有糖尿病病史,均无冠心病病史。4例患者有长期吸烟史,3例患者有长期饮酒史。1例患者有食管癌家族史。病变位置:食管病变均为胸中段,胃窦2例,贲门2例,胃体1例。一例患者为环周病变。5例患者水平及垂直切缘均为阴性,且均为治愈性切除。术后病理:食管病变3例为鳞状细胞癌,2例为高级别上皮内瘤变。胃部病变1例为黏膜内腺癌,2例为高级别上皮内瘤变,2例为低级别上皮内瘤变。在随访期间无患者复发,1例患者死亡,死亡原因不详,另外4例患者术后无特殊不适。结论 食管和胃双原发早期癌及癌前病变同时行ESD安全可行且短期预后较好。

【Obejective】 To explore the feasibility,safety,efficacy and prognosis of endoscopic submucosal dissection(ESD)for simultaneous treatment of double primary early and precancerous cancers of the esophagus and stomach.【Methods】 The clinical data of all patients who received ESD treatment for esophagogastric diseases in Taihe Hospital of Shiyan City from January 1,2014 to October 1,2020 were retrospectively analyzed.The patients were followed up for a total of 3 to 24 months.【Results】 Of the 5 patients,4 were male and 1 was female.The oldest age is 71,the youngest is 64,and the average age is 67.One patient had a history of hypertension,one patient had a history of diabetes,and none had a history of coronary heart disease.Four patients had a long history of smoking,and three patients had a long history of alcohol consumption.One patient had a family history of esophageal cancer.Location of lesions:all the esophageal lesions were in the middle thoracic section,2 cases in the gastric antrum,2cases in the cardia,and 1 case in the gastric body.One patient had circumferential lesions.All the 5 patients had negative horizontal and vertical margins,and all were treated with curative resection.Postoperative pathology:3 cases of esophageal lesions were squamous cell carcinoma and 2 cases were high-grade intraepithelial neoplasia.Gastric lesions included 1 case of intramucosal adenocarcinoma,2 cases of high-grade intraepithelial neoplasia,and 2 cases of low-grade intraepithelial neoplasia.There was no recurrence during the follow-up period,and 1 patient died,the cause of death is unknown,and the other 4 patients had no special discomfort after surgery.【Conclusion】 Simultaneous ESD is safe,feasible and has good short-term prognosis for double primary early cancer of esophagus and stomach and precancerous lesions.