早期贲门癌及癌前病变的内镜微创治疗研究  

Value of Endoscopic Minor-injury Treatment for Early Cardia Cancer and Precancerous Lesions

作　　者：张立玮[1] 王士杰[1] 于卫芳[1] 吴明利[1] 郭晓青[1] 李英赛[1] 王顺平[1] 牛巍巍[1] 袁丽[1] 

机构地区：[1]河北医科大学第四医院内镜科,石家庄市050011

出　　处：《中国肿瘤临床》2008年第22期1261-1264,共4页Chinese Journal of Clinical Oncology

基　　金：国家十一五科技支撑计划课题(编号:2006BA102A07);河北省普通高等学校强势特色学科(编号:冀教高[2005]52号);河北省科技攻关计划课题基金资助(编号:07276101D-63)~~

摘　　要：目的:内镜微创治疗早期贲门癌及癌前病变,探讨治疗价值。方法:应用内镜黏膜切除(Endoscopic mu-cosal resection,EMR)和氩离子凝固(Argon plasma coagulation,APC)方法治疗高发区门诊及内镜筛检出的早期贲门癌及癌前病变104例108个病灶,统计分析病变位点分布、适应证、并发症及随访情况。结果:1)74.1%的病灶位于贲门12点至3点位,25.9%的病灶位于其他点位,差异有统计学意义(P<0.01)。2)EMR治疗前后病理:有4个病灶为中度不典增生、术后1个病灶被诊断为黏膜内癌;有36个病灶重度不典型增生,其中术后有3个病灶被诊为黏膜内癌,1个病灶被诊为早期浸润癌;10个病灶黏膜内癌,术后1个灶诊为早期浸润癌。3)EMR组治疗成功率96%,2个灶术后诊为早期浸润癌追加手术。4)APC组早期贲门癌治疗成功率为83.3%,癌前病变治疗成功率为100%。5)EMR组合并出血发生率为4.0%;APC组出血发生率1.7%,无其他并发症。6)EMR组随访3年生存率为100%,5年生存率为92.3%;APC组5年生存率为100%。结论:1)早期贲门癌及癌前病变存在高发部位,对该部位精细观察和活检,有望提高贲门病变检出率。2)将随诊6个月以上内镜及病理诊断无好转的中度不典型增生纳入治疗范围,可有效避免治疗不足。3)黏膜下注药是减少内镜治疗并发症的重要措施。4)EMR和/或APC治疗方法简便易行、安全有效、易于推广。Objective：TO investigate the therapeutic value of micro-injury technology of endoscopy for the treatment of early cardia cancer and precancerous lesions. Methods： Endoscopic mucosal resection （EMR） and Argon plasma coagulation （APC） were performed on 108 lesions of early cardia cancer or precancerous lesions in 104 patients in a high incidence area. The distribution of sites, treatment indication and results of follow-up were analyzed. Results： Seventy-one percent of these lesions were located in 12 to 3 clock sites of cardia, and 25.9% were in other clock sites of cardia, with a significant difference （P〈0.01）. Pre- and post-EMR patho- logical comparison showed that one lesion （1/4） of moderate dysplasia identified by pre-operative pathology was confirmed as intramucosal carcinoma after EMR. Three lesions （3/36） of severe dysplasia identified by pre-operative pathology were confirmed as intramucosal carcinoma, and one lesion （1/36） was confirmed as early invasive carcinoma after EMR. One lesion （1/10） of intramucosal carcinoma was diagnosed as early invasive carcinoma after EMR. Two lesions were diagnosed as early invasive carcinoma according to post-pathology and other leisons were successfully treated in EMR group. The success rate of EMR was 96%. The success rate of APC was 83.3% for intramucosal carcinoma, and 100% for precancerous lesions. The main complications included hemorrhage in 2 cases （4.0%） in EMR group and 1 case （1.7%） in APC group. Perforation and stenosis were not observed. , the 3- and 5-year survival rates were 100% and 92.3% in the EMR group and 100% in the APC group. Conclusion： Early cardia cancer and precancerous lesions are mainly located on 12 to 3 clock sites of cardia, indicating that close observation of these sites would improve the detection rate of cardia lesions. Sufficient submucosal injection is an important measure to avoid the complications of endoscopic treatment. Treatment with EMR and APC is simple, accurate, efficient and safe

关 键 词：早期贲门癌 内镜黏膜切除术氩离子凝固术 高发区 

分 类 号：R735.2[医药卫生—肿瘤]