内镜下食管黏膜切除并发症的预防和治疗

Prevention and treatment of complications after endoscopic esophageal mucosal resection for early esophageal cancer and precancerous lesion

目的 探讨内镜食管黏膜切除术治疗早期食管癌及其癌前病变并发症的预防与治疗。方法 应用透明帽法对71例早期食管癌及食管鳞状上皮重度异型增生患者进行食管黏膜切除。结果 71例患者共切除88块病变,每块切除病变黏膜下平均注射肾上腺素盐水18 ml,切除标本大小为(21.8±1.0)mm×(18.2±1.0)mm。术后5例出血,其中1例动脉出血,4例渗血,应用内镜压迫、肾上腺素盐水注射及氩离子凝固术治疗均成功止血;术后4例发生狭窄,其中3例是由于切除直径超出食管全周3/4,术后1个月应用水囊扩张,狭窄均缓解。未有穿孔等严重并发症发生。结论透明帽法食管黏膜切除术是一种较为简便、安全、有效的黏膜切除方法,如果操作得当,可明显减少并发症的发生。

Objective To evaluate the treatment outcome of endoscopic esophageal mucosal resection (EMR) and alleviate or prevent the complication of EMR. Methods We explore a strategy of endoscopic esophageal mucosal resection to treat early esophageal cancer and severe dysplasia . Endoscopic esophageal mucosal resection was performed with transparent-cap technique, resdiual lesions were treated by Argon Plasma Cocagulation( APC). All patients have been followed up by endoscopic examinations at one month, 4 months, and 12 months after therapy. Results Seventy one cases (88 lesions) were treated by endoscopic esophageal mucosal resection with transparent-cap method. Average doses of saline-epinephrine 18 ml is injected submucosally to each lesion. The resected specimens were on average(21.8 ±1.0)mm × (18.2±1. 0)mm in size. Five cases have bleeding after mucosectomy, bleeding were managed and controlled by compression , local injection of saline-epinephrin, and APC. Perforation never occurred. Four cases have stenosis after mucosal resection, in three of them the resected area was more than 3/4 esophageal circumference, then it was dilated with water ballon dilater at one month, two months and three months after mucosal resection, all cases were cured. Conclusions Endoscopic esophageal mucosal resection is a safe, simple, minimally invasive and effective procedure with few complication in treating early esophageal cancer and precan-cerous lesion.