内镜下黏膜多环套扎切除术治疗食管癌前病变和食管早癌的近期疗效和安全性分析  

Analysis of the short-term efficacy and safety of endoscopic mucosal band ligation in the treatment of esophageal precancerous lesions and esophageal early cancer

作　　者：任重[1] 钟芸诗[1] 周平红[1] 时强[1] 陈涛[1] 周嘉敏[1] 姚礼庆[1] 

机构地区：[1]复旦大学附属中山医院内镜中心复旦大学内镜诊疗研究所,上海200032

出　　处：《中华胃肠外科杂志》2013年第5期425-428,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81101566）;上海市科委重大课题（11411950500）;上海市卫生局人才基金（XYQ2011017）;上海市科委启明星计划（12QA1400600）;上海市消化内镜诊疗技术工程研究中心（1IDZ2280400）

摘　　要：目的探讨内镜下黏膜多环套扎切除术（EMBL）治疗食管癌前病变和早癌的近期疗效和安全性。方法回顾性分析2012年1-11月在复旦大学附属中山医院内镜中心接受EMBL治疗的21例食管癌前病变和早期食管癌患者的临床资料，总结治疗效果及术后并发症发生情况。结果21例患者均顺利完成EMBL术。手术时间（21．0±8．3）min。术后无皮下气肿、纵隔气肿、气胸及迟发性出血病例。2例患者术后1个月出现食管创面狭窄，经气囊扩张术后症状缓解。术后病理示：中度不典型增生1例，中-重度不典型增生2例，重度不典型增生10例，原位癌2例，早期鳞癌6例。除1例早期鳞癌患者因癌灶距离切缘仅1mm，遂追加开胸食管癌根治术外，其余患者切缘均阴性。随访期间未见复发病例。结论EMBL术可有效治愈食管癌前病变和早期食管癌，具有微创、安全、操作简单的优点。Objective To evaluate the short-term efficacy and safety of endoscopic mucosal band ligation （EMBL） in the treatment of esophageal precancerous lesions and esophageal early cancer. Methods Clinicopathological data of 21 cases with esophageal precancerous lesions and esophageal early cancer undergoing EMBL at the Endoscopic Center in Zhongshan Hospital of Fudan University from January 2012 to November 2012 were analyzed retrospectively. Short-term efficacy and complications after operation were summarized. Results All the 21 cases underwent EMBL operation successfully. The mean operative time was （21.0 ＋8.3） minutes. No subcutaneous emphysema, mediastinal emphysema, pneumothorax or delayed bleeding occurred. Esophageal stricture occurred in 2 cases and the symptoms were alleviated after balloon dilation. Pathological examination showed moderate dysplasia （n=l）, moderate-severe dysplasia（n=2）, severe dysplasia（n=10）, carcinoma in situ（n=2） and early stage of squamous cell carcinoma（n=6）. All the resection margins were negative except for 1 case of early stage squamous cell carcinoma, whose margin was only 1 mm and so underwent additional open surgery for esophageal cancer. No relapse of cancer was found during follow-up. Conclusion EMBL can cure esophageal precancerous lesions and esophageal early cancer effectively and is safe, minimally invasive and simple to perform.

关 键 词：食管癌前病变 食管早癌 内镜治疗 内镜下黏膜多环套扎切除术 

分 类 号：R735[医药卫生—肿瘤]