早期食管癌内镜下手术后接受食管切除的比较分析  

Comparative analysis of esophagectomy after endoscopic resection in early stage esophageal cancer

作　　者：张杰 陈海泉[1,2,3] 相加庆 张亚伟[1,2] 黄洋乐 陈苏峰[1,2] 王胜飞 王瑞[1,2] James Luketich 

机构地区：[1]复旦大学附属肿瘤医院胸外科,上海200032 [2]复旦大学上海医学院肿瘤学系 [3]上海交通大学附属胸科医院胸外科,200030 [4]美国匹兹堡大学胸心外科,15213

出　　处：《中华胸部外科电子杂志》2015年第1期35-39,共5页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的探讨早期食管癌患者行内镜下切除术（ER）后是否需要二次行食管癌根治术的影响因素。方法选择2011年6月至2014年3月在复旦大学附属肿瘤医院胸外科收治的经ER手术治疗的早期食管癌患者，根据是否继续行食管癌根治术分组并随访，对食管癌根治术后未见癌残留的病例进行包括浸润深度（T分期）、病灶长度（〈3cm或≥3cm）、病灶位置（上、中、下段）、分化程度以及有无淋巴管脉管侵犯的相关性统计分析，统计学方法采用χ^2检验。结果共有88例患者术前检查和分期提示为早期食管癌患者接受ER术，再次行食管癌根治术有22例（25．0%），其中7例（31．8％）最终病理未见肿瘤残留。统计学分析显示：ER病灶浸润深度（T0-1a期或T1b期以上）对于是否需行二次根治术具有预测作用（χ^2=8．56，P=0．005），而病灶长度、位置、分化程度以及有无淋巴管脉管侵犯未见明显影响（χ^2=1．89，P=0．361；χ^2=3．01，P=0．165；χ^2=3．85，P=0．121；70=1．02，P=1．000）。结论根据ER术后的病理结果：T0—1a且切缘为阴性的患者，食管切除多能避免；而T1a以上，特别是内镜黏膜下剥离术（ESD）中黏膜下注射亚甲蓝抬举不满意或内镜下黏膜切除术（EMR）圈套不满意者，推荐行食管癌根治术。对于贲门处的早期癌，ER手术的选择要慎重。Objective The aim of this study is to investigate the related factors indicating necessarily second esophagectomy after the treatment of endoscopic resection （ER） in early stage of esophageal cancer. Methods From June 2011 to March 2014, the data of patients with early stage esophageal cancer treated with ER were prospectively collected from the Department of Thoracic Surgery of Shanghai Cancer Hospital. Patients with or without further esophagectomy were followed up, and statistical analysis was carried out based on the factors including the depth of invasion（T grade）, the depth of invasion of ER lesion（T0-1a or beyond Tla）, the length of lesion（〈3 cm or ≥3 cm）, the location of tumor（upper, middle or lower）, the degree of differentiation, and with or without lymph vascular invasion among patients without tumor residual after esophagectomy. Results Eighty-eight patients with early stage esophageal cancer indicated by preoperative examination and staging underwent ER surgery, and 22（25.0%） of them received further esophagectomy, among whom 7（31.8%） had no tumor residual according to the final pathological reports. Statistical analysis showed that the invasive depth of ER lesion （T0-1a or above Tlb） was a predicting factor which could indicate whether the patient need further radical surgery or not（χ^2 = 8.56, P= 0. 005）, while that had no significant effect on the length of lesion, location of lesion, differentiation degree and lymphatic vessel invasion（χ^2 = 1.89, P= 0.361;χ^2=3.01,P=0.165;χ^2=3.85,P=0.121;χ^2=1.02,P=1.000）. Conclusions Patients with lesions at stage T0-1a and negative surgical margin based on the pathological results can probably avoid esophagectomy after ER. While those beyond TIa stage, especially those with dissatisfaction about ESD mucosal protrusion after submucous injection with Methylene blue or endoscopic mucosal resection （EMR） mucosal trap, were recommended for esophagectomy. As for early stage cardia cancer, it should be very cautio

关 键 词：内镜下手术 早期食管癌 食管癌根治术 

分 类 号：R735.1[医药卫生—肿瘤]