ESD治疗食管早癌及上皮内瘤变的价值  

The value of ESD in the treatment of esophageal cancer and intraepithelial neoplasia

作　　者：程如焕 郭慧敏[2] 汪忠红 贾华锋 张玉莲 CHENG Ru-huan;GUO Hui-min;WANG Zhong-hong;JIA Hua-feng;ZHANG Yu-lian(HongzeHuaian District People′s Hospital Huaian 223100 China;Nanjing Drum Tower Hospital The AffiliatedHospital of Nanjing University of Medical Hospital Nanjing 210008 China)

机构地区：[1]淮安市洪泽区人民医院,223100 [2]南京大学医学院附属南京鼓楼医院,210008

出　　处：《现代消化及介入诊疗》2018年第5期541-543,547,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然青年基金项目(81502038)

摘　　要：目的探讨内镜黏膜下剥离术(ESD)在治疗早期食管癌及上皮内瘤病变中的应用价值。方法选取2014年1月至2017年1月于淮安市洪泽区人民医院确诊并行ESD手术切除治疗的100例食管早期癌及上皮内瘤变患者为研究对象,记录手术时间、病灶长度等,观察ESD在不同类型病变中的切除效果,记录术中及术后并发症的发生情况,分析病变占管周面积大小与术后食管狭窄发生率相关性,观察术后2个月、6个月及12个月患者复查情况。结果早期食管癌患者的手术时间、病灶长度均显著多于高级别上皮内瘤变患者(P <0.05),两种疾病类型患者的手术切除效果间比较无显著差异(P>0.05)。术中及术后部分患者出现不同程度的出血、穿孔、胸骨后疼痛等现象,但经对症治疗得到有效缓解。随着病变占管周面积的增加,术后食管狭窄的发生率也随之增加。术后2个月复检创面愈合率为100%,术后6个月复检1例患者出现局灶复发,术后12个月复检又有1例患者出现贲门病变,余未见明显异常。结论 ESD在治疗早期食管癌及上皮内瘤变中具有较高实用价值,值得进行临床推广。Objective To explore the value of endoscopic submucosal dissection ESD in thetreatment of early esophageal cancer and intraepithelial neoplasia. Methods One hundred patients with earlyesophageal cancer and intraepithelial neoplasia who were diagnosed and treated by ESD in Huaion DistrictPeople′s Hospit from January 2014 to January 2017 were studied. The operation time and lesion length wererecorded the resection effect of ESD in different types of lesions was observed the occurrence ofintraoperative and postoperative complications were recorded and the correlation between the size of lesionsand the incidence of postoperative esophageal stenosis was analyzed. The patients were reviewed at 2 months 6 months and 12 months after operation. Results The operation time and length of lesions in patients withearly esophageal cancer were significantly longer than those in patients with high grade intraepithelialneoplasia P 〈 0.05 . There was no significant difference between the two groups in the surgical resection P 〉 0. 05 . The bleeding perforation and retrosternal pain were found in some patients during and afteroperation but the symptomatic treatment was effective. The incidence of postoperative esophageal stenosisalso increased with the increase of lesion area. The rate of wound healing was 100% at 2 monthspostoperatively. One patient had local recurrence at 6 months postoperatively and another patient had cardiaclesion at 12 months postoperatively. Conclusions ESD has high practical value in the treatment of earlyesophageal cancer and intraepithelial neoplasia and is worthy of clinical promotion.

关 键 词：ESD 早期食管癌 上皮内瘤变 

分 类 号：R735.1[医药卫生—肿瘤]