早期食管癌及其癌前病变内窥镜透明帽法食管黏膜切除术  

Minimal invasive treatment of early esophageal cancer and its precancerous lesion: endoscopic mucosal resection using transparent cap-fitted endoscope

作　　者：王贵齐[1] 魏文强[1] 郝长清[2] 张晓华[1] 赖少清[1] 于桂香[1] 菊凤环[1] 马跃华[1] 乔友林[1] 董志伟[1] 王国清[1] 

机构地区：[1]中国医学科学院肿瘤医院,100021 [2]河南省林州市肿瘤医院

出　　处：《中华医学杂志》2003年第4期306-308,共3页National Medical Journal of China

摘　　要：目的 探讨透明帽法食管黏膜切除术治疗早期食管癌及食管鳞状上皮重度不典型增生的意义。方法 应用透明帽法对29例早期食管癌和42例食管鳞状上皮重度不典型增生行食管黏膜切除。应用氩离子束凝固术(APC)治疗残留及复发病灶。术后l、4及12个月进行内镜复查。结果(1)在内镜下应用透明帽法共对71例患者进行了局部黏膜切除,共切除病灶88块。切除标本每块平均为21.8 mm±1.02 mm×18.2 mm±1.02 mm。(2)本组术后5例出血,其中1例动脉出血,4例渗血,应用内镜压迫、肾上腺素盐水注射及氩离子束凝固术治疗均成功止血;71例无一例食管穿孔发生;术后4例发生狭窄,术后一个月应用水囊扩张,每一个月扩张一次,连续扩张3～4次,狭窄均缓解,进食无明显不适感。(3)58例(81.7％)患者的食管黏膜病变被完全切除,其余病例有不同程度的残留,应用氩离子束凝固术治疗残留病变。术后4个月内镜复查,病理证实3例早期癌、2例重度不典型增生局部复发,随访时间24.6个月,无明显不适感。结论 应用透明帽法食管黏膜切除术可简便、安全、有效地治愈早期食管癌及癌前病变。有较好的应用前景。Objective To explore the effect of endoscopic esophageal mucosal resection using transparent cap-fitted endoscope to treat early esophageal cancer and severe hyperplasia, precancerous lesion of esophageal cancer. Methods Endoscopic esophageal mucosal resection were performed with transparent-cap technique on 29 cases of early esophageal cancer and 42 cases of severe hyperplasia, and the residual lesions were treated by Argon plasma coagulation (APC). All patients were followed up by endoscopic examination one month, 4 months, and 12 months after the therapy. Results ( 1) Local esophageal mucosa with the size of 21.8 mm±1.02 mm × 18.2 mm ± 1.02 mm on average was resected from 71 cases, with 88 lesions, using transparent cap-fitted endoscope. 1:1 000 saline-epinephrine at an average dose of 18 ml was injected submucosally for each lesion. (2) After the mucosectomy 5 cases had bleeding which was controlled successfully by compression, local injection of saline-epinephrine, and APC. None case suffered from perforation. Stenosis was found in 4 cases after mucosal resection, in three of which the extent of resected mucosa exceeded 3/4 of the esophageal circumference. Water-balloon dilator was used once a month for 3 - 4 times since one month after mucosal resection. All cases were cured. (3)The lesions of 58 cases (81.2% ) were completely resected, and the remaining cases had residual lesions that were treated by APC. Three cases of early cancer and 2 cases of severe atypical hyperplasia were discovered endoscopically 4 months after resection and were cured by APC. (4) All cases survived without any discomfort after a follow-up of 4.6 months on average. Conclusion Safe, simple, minimally invasive and effective on early esophageal cancer and precancerous lesion, endoscopic esophageal mucosal resection (EEMR) is promising clinically.

关 键 词：食管黏膜切除术 食管肿瘤 食管内窥镜 氩离子束凝固术 

分 类 号：R735.1[医药卫生—肿瘤] R730.56[医药卫生—临床医学]