食管癌前病变内镜下氩离子凝固阻断治疗研究

目的探讨氩离子凝固治疗法(APC)对食管癌前病变的治疗作用.方法对2头猪食管和2份人离体新鲜食管标本进行不同功率、距离、时间、黏膜下注药组合的APC凝固治疗,光镜下观察组织破坏深度,探索可应用到临床的合理治疗参数组合,进而对28例食管癌前病变病人施以APC治疗.分别于术后1,3,6个月,以后每年复查常规内镜、色素内镜及病理.结果 APC凝固治疗的创面颜色呈白色→黄褐色→棕黑色的渐进性变化,组织破坏深度随颜色的变化呈渐进性加深.统计学分析结果,APC法组织破坏深度随功率增大、作用时间的延长而加深,随距离增大、黏膜下注射药物而变浅.临床28例病例中27例治疗后病灶消失,病理结果为炎症;1例病灶累及食管全周经APC治疗3次后病灶缩小至1/3,活检病理检查为鳞状上皮不典型增生Ⅱ,Ⅲ级.结论 APC法是治疗食管癌前病变的有效、简便、安全的新方法,可作为食管癌前病变有效的局部阻断治疗方法推广使用.黏膜下注射药物能保证治疗顺利、安全,是内镜APC治疗方法的重大改进.

Treatment of precancerous lesion of esophagus by endoscopic argon plasma coagulation

Objective: To evaluate the clinical value of argon plasma coagulation (APC) in the treatment of precancerous lesion. Methods: The effect of APC was studied on two pig esophagus and two fresh in vitro esophageal resection specimens using various power settings, pulse duration, separation, and various submucosal liquids injections. Histological appearance and measurement of depth and length of tissue damage area were made through light microscope. In the experiment we found the reasonable combination of power settings, pulse duration, separation,and various submucosal liquids injections. Then twenty-eight patients suffering from histologically confirmed moderate and severe esophageal dysplasia were treated with APC. A follow-up examination of plain endoscopy with Lugol's solution test and histopathological study was used after 1,3,6 months, and then every year.Results: The color of the damaged area was black in the center and gradually changed into brown-yellow and white in the surrounding area. The changing of color reflects the severity of tissue damage. The white color indicates that the epithelia were destroyed, and in the black area the tissue damage deepened to submucosa. The depth varied likes wedge-shaped defect. By statistical analysis, tissue damage increases with the increasing of power setting and pulse duration, decreases with the increasing of separation, and injection makes the damage much shallow. Twenty-eight cases was treated. Twenty-seven cases healed. One case was treated by 3 sessions (The lesion extend to the entire circle of the esophagus) and was found with moderate to severe dysplasia.Conclusions: APC is a new method to treat the precancerous lesion, it can make the treatment simple, safe and effective. Submucosal injection is an important improvement of APC ablation. It make the treatment safe and effective.