【摘要】 食管癌作为全球致死率较高的恶性肿瘤，其发生与吸烟、过度饮酒、长期摄入过热或腌制食品等不良生活习惯相关。在临床治疗领域，其多发性食管癌前病变的规范化治疗仍面临诸多挑战，现有单一治疗技术在应对复杂病灶时存在疗效局限。近年来，内镜下黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）联合射频消融术（RFA）的综合应用逐渐成为临床关注焦点。本研究旨在通过综述近10余年国内外相关研究进展，探讨EMR、ESD联合RFA在多发性食管癌前病变中的适应证、技术特点、疗效评价与安全性管理，分析该策略在临床实践中的可行性与推广价值。现有证据表明，联合治疗可显著提高病灶完全清除率，降低术后狭窄及复发风险，整体并发症发生率低于单一技术治疗。在治疗多灶性、高风险病变时，序贯式个体化操作模式具有良好的适应性与重复性。尽管当前随访结果显示中位无复发生存期可达34个月，但关于长期生存率及复发风险的证据仍显不足。未来需通过多中心、大样本、长期随访研究进一步明确其疗效并推动标准化治疗路径的构建，以更好地指导临床实践。更多还原

【Abstract】 Esophageal cancer, as a highly lethal malignant tumor worldwide, is significantly associated with adverse lifestyle factors such as tobacco smoking, excessive alcohol consumption, and long-term intake of overheated or preserved foods. In clinical practice, the standardized treatment of multifocal esophageal precancerous lesions remains a major challenge, as current single therapeutic modalities often show limited efficacy in managing complex lesions. In recent years, the combined application of endoscopic mucosal resection(EMR), endoscopic submucosal dissection(ESD), and radiofrequency ablation(RFA) has drawn increasing attention. This article aims to systematically review the research progress over the past decade from both domestic and international studies, focusing on the indications, technical characteristics, therapeutic efficacy, and safety management of EMR/ESD combined with RFA in the treatment of multifocal esophageal precancerous lesions. Current evidence suggests that this combined strategy significantly enhances the complete eradication rate of lesions, reduces the incidence of postoperative stricture and recurrence, and demonstrates a lower overall complication rate compared to monotherapies. The sequential and individualized approach offers high adaptability and repeatability, particularly in patients with multifocal or high-risk lesions. Although current follow-up data indicate a median recurrence-free survival(RFS) of up to 34 months, long-term survival outcomes and recurrence risk remain insufficiently studied. Future research should focus on multicenter, large-sample, long-term follow-up studies to further validate its effectiveness and facilitate the development of standardized therapeutic protocols, ultimately improving clinical decision-making and patient outcomes.更多还原