内镜皮圈套扎法黏膜切除术治疗早期食管癌的临床分析  

Treatment of early esophageal cancer with endoscopic mucosal resection using a ligation device

作　　者：彭贵勇[1] 陈磊[1] 龙庆林[1] 赵京晶[1] 彭志红[1] 代剑华[1] 何天湖[1] 周倩[1] 

机构地区：[1]第三军医大学西南医院全军消化病研究所,重庆400038

出　　处：《第三军医大学学报》2012年第19期2009-2011,共3页Journal of Third Military Medical University

基　　金：重庆市科技攻关项目(2008AC5003)~~

摘　　要：目的探讨内镜皮圈套扎法黏膜切除术(endoscopic mucosal resection using a ligation device,EMRL)治疗早期食管癌及癌前病变的价值。方法于2010年1月至2012年4月在西南医院消化内镜中心,对食管黏膜表浅病灶行病理检查明确病灶性质,卢戈液染色确定病灶范围,通过我们的早期食管癌内镜分型标准判断侵犯深度,对66例黏膜及黏膜肌层早期癌及食管黏膜中重度不典型增生病变行EMRL治疗:用氩气刀标记病灶范围,将静脉曲张套扎器安装于双钳道胃镜的先端,从一个钳道连接操作释放装置,对病灶黏膜进行橡皮圈套扎,从另一钳道插入高频电切圈套器切除病灶。观察手术操作时间、并发症及复发率。结果 66例食管黏膜表浅病灶,病理检查为黏膜内食管鳞状细胞癌31例,食管黏膜中、重度不典型增生35例;病灶最大直径1～6 cm,均完全切除;EMRL手术时间5～55 min,平均21 min,1例术中明显出血经电凝止血,无穿孔及术后迟发性出血发生;观察1～26个月无复发。结论在严格适应证下,内镜皮圈套扎法黏膜切除术对早期食管癌癌前病变和限于黏膜层的早期癌是一种有效的治疗手段。study the value of endoscopic mucosal resection using a ligation device （EMRL） for early esophageal cancer and precancerous lesions. Methods Sixty-six patients with early esopha- geal cancer hyperplasia and area of esophageal underwent EMRL for early esophageal mucosal cancer and moderate-severe atypical esophageal in Digestive Endoscopic Center of Southwest Hospital from January 2010 to April 2012. The nature superficial esophageal lesion were assayed with Lugol＇ s solution staining. The invasion depth of cancer was assessed by endoscopic typing. The lesion was removed by marking its area with APC, placing a variceal ligation device on a dual-channel endoscope, connecting an operating device to a channel, and inserting a high frequency electrocoagulation ligation device through another channel. The procedure time and incidence of complications and relapse were observed and recorded. Results Of the 66 patients with superficial esophageal mucosal lesion, 31 were diagnosed with esophageal intra-mucosal squamous cell carcinoma and 35 were diagnosed with moderate-severe atypical esophageal mucosal hyperplasia. The maximal diameter of esophageal cancer was 1 - 6 cm. The time of EMRL was 5 - 55 min （mean 21 min）. Significant bleeding occurred during operation and stopped after electrocoagulation hemostasis. No perforation and delayed bleeding occurred after operation. The patients were followed up for 1 - 26 months during which no recurrence of esopha- geal cancer was observed. Conclusion EMRL is an effective procedure for esophageal mucosal cancer and precancerous lesions when its indications are strictly controlled.

关 键 词：食管 早期癌 黏膜切除术 

分 类 号：R573[医药卫生—消化系统] R730.56[医药卫生—内科学]