内镜黏膜下剥离术治疗下咽早期癌及癌前病变的疗效观察  

Efficacy of Endoscopic Submucosal Dissection for Early Hypopharyngeal Carcinoma and Precancerous Lesions

作　　者：黄翠香 赵锐[2] 包郁[2] 刘新冰 刘武松 陈曦 Huang Cuixiang;Zhao Rui;Bao Yu;Liu Xinbing;Liu Wusong;Chen Xi(Department of Gastroenterology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Endoscopy,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院消化内科,四川泸州646000 [2]四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院内镜科,成都610041

出　　处：《肿瘤预防与治疗》2023年第2期133-140,共8页Journal of Cancer Control And Treatment

基　　金：四川省医学青年创新科研课题计划(编号:Q19040)。

摘　　要：目的:分析66例下咽早期癌及癌前病变患者行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD的治疗效果。方法:回顾性分析2015年12月至2022年9月经内镜及病理确诊的66例下咽早期癌及癌前病变患者临床病例资料,对ESD整块切除率、完全切除率、治愈性切除率、病灶大小、手术时间、术后并发症、随访情况等指标进行评价。结果:66例76处下咽早期癌及癌前病变接受ESD治疗,ESD整块切除率100%(76/76),完全切除率90.8%(69/76)。病变直径10~50 mm,中位直径22 mm。手术时间15~218 min,中位手术时间60 min。ESD术后喉水肿发生率21.2%(14/66),无1例行临时性气管切开;吸入性肺炎发生率9.1%(6/66);下咽病变直径大于30mm,ESD术后并发症的发生率为33.3%(5/15),且易合并多种并发症。ESD术后病理提示4处基底切缘阳性,其中1处存在脉管浸润;2处水平切缘阳性;1处脉管浸润、基底切缘及水平切缘均阳性;1处脉管浸润,治愈性切除率89.5%(68/76)。患者术后随访时间1~77个月,中位时间25.5个月,2例患者出现咽部管腔狭窄;1例患者出现颈部淋巴结转移,追加放化疗后颈部淋巴结消失。5年总生存率为72.0%及无复发生存率为97.1%。结论:ESD治疗下咽早期癌及癌前病变是一种安全且有效的微创治疗手段。Objective:To analyze the therapeutic effect of endoscopic submucosal dissection(ESD)in 66 patients with early hypopharyngeal carcinoma and precancerous lesions.Methods:Clinical data of 66 cases of early hypopharyngeal cancer and precancerous lesions confirmed by endoscopy and pathology from December 2015 to September 2022 were analyzed retrospectively.The en bloc resection rate,complete resection rate,curative resection rate,lesion size,operation time,postoperative complications and follow-up were evaluated.Results:66 cases with 76 lesions received ESD,with the en bloc resection rate of 100%(76/76)and the complete resection rate of 90.8%(69/76).The median length of lesions was 22 mm(10-50 mm),and the median operation time was 60 minutes(15-218 minutes).The incidence of laryngeal edema after ESD was 21.2%(14/66),and no temporary tracheotomy was performed.The incidence of aspiration pneumonia was 9.1%(6/66).When the length of hypopharyngeal lesions was greater than 30 mm,the incidence of postoperative complications of ESD was 33.3%(5/15),and it was quite likely to be multiple complications.Pathological results revealed that 4 lesions had positive vertical margin,including 1 lesion with vascular invasion;2 lesions had positive horizontal margin;1 lesion had vascular invasion,with positive vertical and positive horizontal margins;1 lesion had vascular invasion,with the curative resection rate of 89.5%(68/76).The median follow-up period was 25.5 months(1-77 months).2 patients had pharyngeal stenosis;1 patient developed cervical lymph node metastasis which disappeared after additional chemoradiotherapy.The 5-year overall survival rate was 72.0%,and the recurrence-free survival rate was 97.1%.Conclusion:ESD is safe,effective and minimally invasive for early hypopharyngeal carcinoma and precancerous lesions.

关 键 词：下咽早期癌 癌前病变 内镜黏膜下剥离术 

分 类 号：R730.56[医药卫生—肿瘤]