内镜下射频消融术治疗范围广泛的0-Ⅱb型早期食管鳞状细胞癌及癌前病变的临床效果  

The effectiveness of radiofrequency ablation on eradicating widespread early 0-Ⅱ b esophageal squa- mous cell carcinoma and precancerous lesions

作　　者：张月明[1] 贺舜[1] 吕宁[2] 薛丽燕[2] David E Fleischer Bas Weusten Sanford M Dawsey 窦利州[1] Jacques JGHM Bergman 王贵齐[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院内镜科,100021 [2]北京协和医学院中国医学科学院肿瘤医院病理科,100021 [3]Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA [4]Department of Gastroenterology and Hepatology, StAntonius Hospital, Nieuwegein, the Netherlands [5]Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda,MD, USA [6]Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands

出　　处：《中华消化内镜杂志》2015年第9期586-590,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜下应用HALO射频消融系统（Radiofrequency Ablation，RFA）治疗范围广泛的早期表浅平坦型（0-Ⅱb）食管鳞状细胞癌及癌前病变的治疗效果。方法对中国医学科学院肿瘤医院自2008年10月至2011年6月应用HALO射频消融系统治疗的33例早期食管鳞状细胞癌（early esophageal squamous cell cancer，EESCC）、重度不典型增生（high grade dysplasia，HGD）及中度不典型增生（middle grade dysplasia，MGD）患者的临床资料进行分析，观察治疗后1年病变组织学上完全缓解率（CR）及并发症情况。结果33例患者中，男26例，女7例，年龄平均61岁，MGD10例，HGD17例，EESCC6例，病变长度3～12（平均7．9）cm，治疗区域长度5～14（平均9．9）cm，累及食管周径平均11／12周。33例患者首次治疗手术时间11～57（平均30）min，平均住院时间3天。首次治疗后3个月内镜随访CR达69．7％（23／33），随访期间追加治疗1—4（平均2．7）次，12个月内镜随访时CR达93．9％（31／33）。4例（12％）术后出现重度狭窄，行内镜下水囊扩张术3—12（平均7）次，扩张后均缓解。无其他并发症发生。结论RFA治疗范围广泛的0-Ⅱb型早期食管鳞状细胞癌和癌前病变是安全的、有效的且是一项对于操作者技术要求较低的技术，扩大了内镜微创治疗的适应证。Objective To evaluate the effectiveness of radiofrequency ablation （RFA） on eradicating widespread early 0-Ⅱ b esophageal squamous cell carcinoma （ESCC） and precancerous lesions. Methods Retrospective analysis was performed on 33 patients with early 0-Ⅱ b ESCC, high and middlegrade dysplasis （ HGD, MGD） between October 2008 and June 2011 at Cancer Institute and Hospital, Chinese Academy of Medical Sciences for the proportion of patients with histological complete response （CR） and adverse events after 12 months. Results In 33 patients, of whom 26 were male, 7 were female, mean age being 61years old with MGD （10）, HGD （17）, EESCC （6）. USL length was 3-12 （mean 7. 9）cm. Treatment area （TA） length was 5-14 （ mean 9. 9 ） em, and the esophagus was involved 11/12 circumference. Primary RFA treatment time was 11-57 （mean 30 ）min and average hospitalization day was 3 days. CR was 69. 7% （23/33） after one RFA session in 3 months, and was 93.9% （31/33） after 12 months. There were 4（ 12% ）severe strictures, who received dilation 3-12 （mean 7 ） times, and symptoms were relieved. There was no other complication. Conclusion RFA is effective, safe and less technique-demanding in treating patients with widespread 0-Ⅱb esophageal squamous cell neoplasia and precancerous lesions, extending the indications of endoscopic treatment.

关 键 词：射频消融术 食管肿瘤 早期食管鳞状上皮细胞癌 癌前病变 

分 类 号：R735.1[医药卫生—肿瘤]