【作者】 吴明利； 王士杰； 张立玮； 郭哓青； 徐志彬； 尔丽绵； 王顺平； 李英赛； 高扬； 丛庆文；

【Author】 Wu Ming-Li Wang Shi-Jie Zhang Li-Wei GuoXiao-Qing Xu Zhi-Bin ErLi-mian Wang Shun-Ping Li Ying-Sai Gao Yang Cong Qing-Wen Department of Endoscopy, the Fourth Hospital of Hebei Medical University

【机构】 河北医科大学第四医院河北省肿瘤医院内镜室；

【摘要】 目的:我国是食管癌高发,发病人数占世界50％以上,总体5年生存率不足10％,严重危害人民的生命与健康。一般认为食管鳞状上皮的不典型增生是癌前病变,是食管癌变的必经过程。轻度不典型增生发展缓慢,癌变危险度很低, 中度不典型增生癌变机率明显增加,重度不典型增生自然逆转机率很小。因此,中度和重度不典型增生的阻断治疗是控制和预防食管癌发生发展的关键。而内镜黏膜切除术则是最重要早治技术,引入癌前病变的阻断治疗应具有广阔的应用前景。方法:对内镜检出的食管中、重度不典型增生患者,病灶<3cm,采用内镜套帽法黏膜切除治疗,切除标本详细病理检查。标本边缘为正常组织者,判定为完全切除。所有病例在第1、3、6、12个月复查,以后每年复查。结果:内镜黏膜切除治疗36例中,中、重度不典型增生分别为11例和15例; 完全切除32例(88．89％),随着病灶增大,完全切除率下降。4 例切除不全者,补APC治疗,获愈。术前、术后病理不符共 13例(36．11％),其中重度不典型增生术后诊断为癌7例(28． O％),中度不典型增生术后诊断重度不典型增生2例(18．18％), 癌1例(9．09％),合计3例(27．27％)。本组病例随访5年以上3 例,3～5年9例,1～3年16例,不足1年8例,未见复发、癌变,非原切除部位再发3例。非癌死亡1例。1例出血,无穿孔,狭窄发生。结论:内镜黏膜切除法是合理、有效治疗食管癌前病变的方法,尤适于重度不典型增生灶的治疗。套帽切除法优于strip biopsy法,完全切除率高,简便易掌握。内镜黏膜切除治疗中,病灶的显示及切除的技巧是影响完全切除的主要因素。准确吸入、套扎是完全切除的关键技巧。内镜黏膜切除治疗中,预防并发症的关键是适量的黏膜下注药、掌握高频电电切技术和黏膜的套扎技术。更多还原

【Abstract】 Objective: China is a high-incidence country of esophageal squmous cancer(ESC), more than 50% of all esophageal cancer patients in the world are Chinese, the five-year survival rate of this disease on the whole was less than 10%, the human being are threatened by ESC greatly. Usually dysplasia of esophageal squamous epithelium is called precancerous lesion, which is the inevitable process of esophageal squamous cell carcinogensis. Mild dysplasia(mD) evolves slowly, has a low risk of developing cancer. The risk of developing cancer in moderate dysplasia(MD) increases obviously, and the probability of severe dysplasia(SD) disappeared unaffectedly is few. So treatment of MD and SD is the key measure for controlling and preventing esophageal cancer. Methods: Cases with MD and SD of esophagus were diagnosed by endoscopy. If the lesion of them was less than 3cm it was resected using a cap by endoscope, and the cut specimens were examined histologically. If the edge of the specimens is normal tissue we believed lesions were removed completely. All cases were followed up by endoscopy in the 1th, 3th, 6th and 12th month and one time each year in subsequent time. Results: EMR was performed with a cap in 36 patients. The lesions were resected completely in 32 patients(88.89%). The probability of removed completely decreased with the increasing of lesion size. After operated, histological results of 13 cases(36.11%) were not consistent with primary results, 7 SD cases (28.0%) were diagnosed as cancer after operation, 2 MD cases(18.18%) were diagnosed as SD and 1 (9.09%) was diagnosed as cancer. Endoscopic follow-up was carried out in 3 patients for more than 5 years, 9 patients for 3-5 years and 16 patients for 1-3 years, 8 patients for less than 1 year, no recurrence occurred during the period, 3 cases new lesions were appeared in other area, 1 patients died of other diseases, Oozing bleeding occurred in 1 cases after resection, but there was no perforation and stricture. Conclusion: EMR is effective and appropriate for treating esophageal precancerous lesion, especially for SD. EMR using a cap is better than strip biopsy, the front means is easy to operate and has a high complete removal rate. In the operation of EMR, the displaying of lesions and manipulating skill are important factors for resecting completely. The key techniques for the operation are indraught and ligation nicely. Proper submucosal injection and holding the techniques of high-frequency electric and ligation is the key for preventing complication in EMR.更多还原