内镜下黏膜剥离术治疗同时性多发食管和下咽浅表鳞状细胞癌及癌前病变的疗效分析及初步经验探讨  

Clinical analysis and preliminary experience of endoscopic submucosal dissection for treatment of simultaneous multiple esophagus and hypopharynx superficial squamous cell neoplasms and precancerous lesions

作　　者：蔡明琰 耿子寒 宋宝回 沈纳[2] 钟芸诗 周平红 周旭[2] Cai Mingyan;Geng Zihan;Song Baohui;Shen Na;Zhong Yunshi;Zhou Pinghong;Zhou Xu(Endoscopy Center and Endoscopy Research Institute,Zhongshan Hospital,Fudan University Shanghai Collaborative Innovation Center of Endoscopy,Shanghai 200032,China;Department of Otorhinolaryngology-Head&Neck Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院内镜中心及研究所,上海市消化内镜协同创新中心,上海200032 [2]复旦大学附属中山医院耳鼻咽喉头颈外科,上海200032

出　　处：《中华转移性肿瘤杂志》2024年第3期202-206,共5页Chinese Journal of Metastatic Cancer

基　　金：上海市卫生健康委卫生行业临床研究专项(202340178);上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2023CRT006)。

摘　　要：目的探讨内镜黏膜下剥离术(ESD)治疗同时性多发食管和下咽浅表鳞状细胞癌及癌前病变的疗效、安全性以及初步经验。方法回顾分析2017年8月至2022年7月复旦大学附属中山医院就诊的11例同时性多发食管和下咽浅表鳞状细胞癌接受ESD治疗患者的疗效、安全性,并根据随访结果评估生存、局部复发和转移情况。结果所有患者均成功进行食管和下咽浅表病变的内镜切除。下咽病变的中位直径为18.0 mm(15.0~22.0 mm),食管病变的中位直径为27.0 mm(22.5~36.0 mm)。下咽病变中9例(9/11,82%)整块切除,6例(6/11,55%)完整切除;食管病变均实现了整块、完整切除(R0)。术后病理评估下咽病变中,2例(18.2%)为高级别上皮内瘤变,9例(81.8%)为鳞状细胞癌;食管病变中,2例(18.2%)为高级别上皮内瘤变,9例(81.8%)为鳞状细胞癌。所有患者在ESD后均未出现严重出血或穿孔等早期并发症。全部患者ESD术后无复发生存率为73%(中位无复发生存期为57.5个月),无进展生存率为64%(中位无进展生存期为61.0个月)。结论ESD治疗同时性多发食管和下咽浅表鳞状细胞癌可能具有良好的疗效,值得大样本研究。在随访胃镜检查时直接行放大胃镜有利于发现早期病变,加强对侧梨状窝的观察尤为重要。Objective To explore the efficacy,safety and preliminary experience of endoscopic submucosal dissection(ESD)for treatment of simultaneous multiple esophageal and hypopharyngeal superficial squamous cell carcinoma and precancerous lesions.Methods The efficacy and safety of 11 patients with concurrent multiple esophageal and hypopharyngeal superficial squamous cell carcinoma receiving ESD at Zhongshan Hospital affiliated to Fudan University from August 2017 to July 2022 were retrospectively reviewed,and their survival,local recurrence and metastasis were evaluated based on the results of follow-up.Results ESD successfully removed all multiple superficial lesions in the hypopharynx and esophagus in all patients.The median diameter of hypopharyngeal lesions was 18 mm(15.0-22.0 mm),and that of esophageal lesions was 27 mm(22.5-36.0 mm).En bloc resection was achieved in 9 out of 11(82%)hypopharyngeal lesions.6 out of 11(55%)hypopharyngeal lesions achieved complete resection(R0 resection).Postoperative pathological evaluation of the hypopharyngeal lesions showed high-grade intraepithelial neoplasia in two cases(18.2%)and squamous cell carcinoma in nine cases(81.8%),and of the oesophageal lesions,high-grade intraepithelial neoplasia in two cases(18.2%)and squamous cell carcinoma in nine cases(81.8%).All esophageal lesions achieved both en bloc resection and complete resection.No patients experienced severe early complications such as bleeding or perforation after ESD.Survival analysis results showed that the recurrence-free survival rate was 73%(median recurrence-free survival time:57.5 months),and the progression-free survival rate was 64%(median progression-free survival time:61.0 months).Conclusions ESD for concurrent multiple esophageal and hypopharyngeal superficial squamous cell carcinoma have good efficacy and worthy of large sample studies.Direct magnifying gastroscopy during the follow-up gastroscopy is beneficial to detect early lesions,and it is particularly important to strengthen the observation of the contr

关 键 词：内镜黏膜下剥离术 浅表鳞状细胞癌 同时性食管癌和下咽癌 治疗结果 

分 类 号：R739.63[医药卫生—肿瘤]