超声小探头对高发区早期食管癌及癌前病变术前治疗的评估及其影响因素  

The pretherapeutic assessment of early esophageal cancer and precancerous lesions in high-risk area of miniprobe endoscopic ultrasonography and influence factors

作　　者：尔丽绵[1] 张立玮[1] 徐志彬[1] 袁丽[1] 吴明利[1] 王顺平[1] 高扬[1] 曹颖[1] 

机构地区：[1]河北医科大学第四医院内镜室,河北石家庄050011

出　　处：《中国内镜杂志》2013年第3期239-242,共4页China Journal of Endoscopy

基　　金：国家"十一五"科技支撑计划课题(No.2006BA102A07);河北省医学研究重点课题(No.20110119)

摘　　要：目的结合肿瘤相关因素(如病灶大小和位置),评估超声内镜在食管癌高发区早期癌及癌前病变微创治疗前诊断的精确性。方法回顾分析2008年6月～2010年12月在食管癌高发区涉县、磁县进行普查发现的135例早期食管癌及癌前病变患者,所有病例均行超声内镜(EUS)检查,符合镜下治疗标准的内镜辅以碘染色并行透明套帽辅助的内镜下黏膜切除术(EMR),余手术治疗。对所有行EMR术及手术治疗的患者术前EUS及术后病理结果进行对照,并分析病变的大小及位置对EUS准确性的影响。结果 EUS判断食管早期癌及癌前病变黏膜内癌判断的灵敏性、特异性和准确性分别为90.3%、71.9%及85.9%,sm癌为67.7%、89.4%及84.4%。病变<2cm时准确性比病变≥2cm高(P<0.05,χ2=9.76)。结论 EUS对食管癌及癌前病变浸润深度评估的精确性在病变<2cm时显著高于病变≥2cm,病变位于食管中下段诊断准确性也较食管上段高。确定治疗方案前,结合上述因素综合评价病灶内镜可切除性对指导高发区早期食管癌和癌前病变内镜下治疗具有重要价值。[Objective] To evaluate the accuracy of endoscopic ultrasonography （EUS） in the pretherapeutic assessment of early esophageal cancer and precancerous lesions in high-risk area based tumor-related factors such as length and location. [Method] A total of 135 cases of early esophageal cancer and precancerous lesions were analyzed retrospectively based on the EUS results performed in high-risk areas-She County and Ci County from 2008.6 to 2010.12. Endoscopic mucoscal resection （EMR） was performed on lesions qualified the endoscopic treatment criteria, and the rest was removed surgically. After the resection, invasion depth of the lesions was diagnosed by experienced pathologist and was compared with the EUS estimation. [Results] Diagnostic sensitivity, specificity and accuracy of EUS for mucosal lesions and submucosal lesions were 90.3%, 71.9%, 85.9%, 67.7%, 89.4%, 84.4%, respectively. The diagnostic accuracy of EUS was greater in lesions 2cm or less in size than in lesions larger than 2cm（P 0.05, χ2=9.76）. [Conclusion] The diagnostic accuracy of EUS was greater in lesions 2cm in size or less and located at the mid and lower part than in lesions larger than 2cm and in upper esophagus. These findings should be considered when treatment decisions are being taken. EUS has great value in the endoscopic treatment of early esophageal cancer and precancerous lesions in high-risk area.

关 键 词：超声内镜 食管癌高发区 早期食管癌 癌前病变 

分 类 号：R735.1[医药卫生—肿瘤]