食管早期癌和癌前病变超声内镜诊断及内镜下食管黏膜切除术的临床研究  

Diagnostic value of endoscopic ultrasounography and therapic value of endoscopic mucosal resection in early esophageal cancer and precancerous lesions

作　　者：武育卫[1] 彭贵勇[2] 胡文华[1] 高春芳[1] 郭先科[1] 房殿春[2] 

机构地区：[1]解放军150中心医院消化内科,河南洛阳471031 [2]第三军医大学西南医院消化病研究所

出　　处：《胃肠病学和肝病学杂志》2011年第9期785-788,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨食管早期癌和癌前病变超声内镜诊断价值及内镜下食管黏膜切除术的临床治疗价值。方法 61例食管早期癌和癌前病变行超声内镜检查探测病变浸润深度,位于黏膜层及黏膜肌层的食管早期癌和癌前病变行内镜下食管黏膜切除术(EMR),位于黏膜下层的食管早期癌行外科手术治疗。EMR术28例,外科手术33例。比较超声内镜和术后病理判断病变浸润深度。结果超声内镜判断食管黏膜内癌的特异性和敏感性为94.1%(48/51)、98.0%(48/49);黏膜下癌的特异性和敏感性为80.0%(8/10)、72.7%(8/11);鉴别黏膜内癌及黏膜下癌浸润深度准确率为91.8%(56/61)。28例EMR术后病理:14例食管早期癌和12例食管黏膜中重度异型增生完全切除,完全切除成功率为92.9%(26/28),观察3～45个月无复发。结论超声内镜能较准确鉴别食管早期癌和癌前病变浸润深度,黏膜切除术治疗食管早期癌和癌前病变是安全有效的内镜治疗方法。Objective To explore diagnostic value of endoscopic ultrasounography（EUS） and therapic value of endoscopic mucosal resection（EMR） in early esophageal cancer and precancerous lesions.Methods Sixty-one cases with early esophageal cancer and precancerous lesions were examined by EUS to observe the depth of tumor infiltration.Early esophageal cancer and precancerous lesions from mucosa and muscularis mucosae were treated by EMR,early esophageal cancer from submucosa were treated by surgery operation.Twenty-eight cases were treated by EMR,33 cases were treated by surgery operation.The depth of tumor infiltration was compared between the pathological result of postoperative and the result of EUS examination.Results The specificity and sensibility in intramucosal carcinoma by EUS were 94.1%（48/51）,98.0%（48/49）.The specificity and sensibility in submucosal carcinoma by EUS were 80.0%（8/10）,72.7%（8/11）.The diagnostic accuracy in differentiating intramucosal carcinoma from submucosal carcinoma by EUS was 91.8%（56/61）.Postoperative pathology in EMR showed that 14 cases in early esophageal cancer and 12 cases in moderate and severe dysplasia were completely resected and the resection rate was 92.9%（26/28）,no recrudescence occurred during our follow-up period in EMR group.Conclusion Endoscopic ultrasounography is accuracy in assessing the depth of tumor infiltration and EMR is a safe and effective endoscopic therapy for early esophageal cancer and precancerous lesions.

关 键 词：食管早期癌和癌前病变 超声内镜 内镜下黏膜切除术 

分 类 号：R735.1[医药卫生—肿瘤]