食管黏膜病变内镜黏膜下剥离术前和术后的临床病理分析  

Clinicopathological analysis of endoscopic submucosal dissection for esophageal mucosa lesion

作　　者：庄洁 吴洪磊[1] 王洪波[1] 王红娟[1] 陈兆生[1] 郭建强[1] 许伟华[1] Jie Zhuang;Hong-lei Wu;Hong-bo Wang;Hong-juan Wang;Zhao-sheng Chen;Jian-qiang Guo;Wei-hua Xu(Department of Digestive Diseases, the Second Hospital of Shandong University,Jinan, Shandong 250033, China)

机构地区：[1]山东大学第二医院消化内科,济南山东250033

出　　处：《中国内镜杂志》2017年第10期31-36,共6页China Journal of Endoscopy

摘　　要：目的回顾性分析早期食管癌和癌前病变的内镜下特征及临床病理特征,探讨内镜黏膜下剥离术(ESD)治疗的必要性、安全性和有效性。方法纳入2013年5月-2016年4月经白光内镜及病理活检诊断为早期食管癌及上皮内瘤变的患者51例,分析毛细血管袢(IPCL)、碘染色、术前术后病理结果及相关并发症的发生情况。结果 51例患者共58处病变,IPCL分类58处病变中A型8处(13.79%),B1型44处(75.86%),B2型6处(10.34%);术前活检结果 11处(18.97%)为低级别上皮内瘤变(LGIN),42处(72.41%)为高级别上皮内瘤变(HGIN),5处(8.62%)为鳞状细胞癌,术后病理结果 10处(17.54%)病变为LGIN,27处(46.55%)为HGIN,21处(36.21%)病变为鳞状细胞癌,术前术后病理结果符合率为60.34%。微穿孔、狭窄和术后迟发性出血的概率分别为0.00%(0/58)、8.62%(5/58)和3.45%(2/58)。结论 ESD术后食管早癌的检出率显著增加,术前活检对诊断和治疗有指导意义,ESD治疗能减少食管早癌的漏诊。Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity,efficacy and safety of ESD in the treatment.Methods From May2013to April2016,51consecutive patients underwent high-resolution video endoscopy and biopsy,confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included.There were capillary loops(IPCL),iodine-staining,preoperative and postoperative pathology,and complications to analyze.Results51patients had total58lesions,Type A,Type B1,Type B2of IPCL classification were diagnosed in8(13.79%),44(75.86%),6(10.34%).low-grade intraepithelial neoplasia(LGIN),high-grade intraepithelial neoplasia,early esophageal carcinoma of preoperative biopsy were diagnosed in11(18.97%),42(72.41%),5(8.62%),low-grade intraepithelial neoplasia(LGIN),high-grade intraepithelial neoplasia,early esophageal carcinoma of postoperative pathology results were diagnosed in10(17.54%),27(46.55%),21(36.21%),concordance rate of pathological results were60.34%.Complications included micro-perforations(0.00%),strictures(8.62%)and delayed hemorrhage(3.51%),respectively.Conclusion After endoscopic submucosal dissection,detection rate of early esophageal cancer increased significantly,preoperative biopsy had guidance significance in diagnosis and treatment,ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.

关 键 词：早期食管癌 上皮内瘤变 内镜黏膜下剥离术 

分 类 号：R735.1[医药卫生—肿瘤]