内镜黏膜下剥离术治疗环周食管表浅癌的疗效及安全性分析

Efficacy and safety of endoscopic submucosal dissection for circular superficial esophageal cancer

目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗环周食管表浅癌的疗效及安全性。方法2015年1月至2019年12月间,因环周食管表浅鳞癌在南京大学医学院附属鼓楼医院行ESD治疗的74例连续病例纳入回顾性分析,主要观察ESD操作成功率、治愈性切除率、并发症发生情况以及追加治疗情况。结果1例患者中转外科手术,其余73例顺利完成ESD治疗,ESD操作成功率为98.6%。ESD术后病理提示39例达治愈性切除,ESD治愈性切除率为53.4%(39/73)。15例(20.5%)发生术中肌层损伤,1例(1.4%)发生术中穿孔,2例(2.7%)发生迟发性出血,1例(1.4%)发生迟发性穿孔。有11例失访,其余62例获得随访资料,随访时间(36.4±19.0)个月,其中12例追加外科手术,5例追加放化疗。在未行手术且获得随访资料的57例患者中,有49例发生ESD术后食管狭窄,ESD术后食管狭窄发生率为86.0%。结论ESD治疗环周食管表浅癌总体安全,但术中易发生肌层损伤,且治愈性切除率不高,术后食管狭窄发生率高,追加外科手术比例高。

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection(ESD)for circular superficial esophageal cancer.MethodsA retrospective analysis was conducted on 74 consecutive cases of circular superficial esophageal squamous cell carcinoma treated with ESD at Nanjing Drum Tower Hospital from January 2015 to December 2019.The success rate of ESD,curative resection rate,incidence of complications,and additional treatment were mainly observed.ResultsOne case was transferred to surgery,and the remaining 73 cases successfully completed ESD treatment.The success rate of ESD was 98.6%.Postoperative pathology of ESD revealed that 39 cases achieved curative resection,with a curative resection rate of 53.4%(39/73).Intraoperative muscle layer injury occurred in 15 cases(20.5%),and intraoperative perforation occurred in 1 case(1.4%).Two cases(2.7%)experienced delayed bleeding,and one case(1.4%)experienced delayed perforation.Eleven cases were lost to follow-up,and the remaining 62 cases received follow-up for 36.4±19.0 months.Among the follow-up cases,12 underwent additional surgery and 5 cases additional chemotherapy and radiotherapy.Among the 57 patients with follow-up data who did not underwent surgery,49 developed esophageal stenosis after ESD,with an incidence rate of 86.0%.ConclusionESD for circular superficial esophageal cancer is generally safe,but it is prone to muscle layer injury during the operation,with a low curative resection rate,a high incidence of postoperative esophageal stenosis,and a high proportion of additional surgical procedures.