消化道内镜诊治早期癌前病变62例回顾性分析

目的 分析经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)诊治消化道早期癌前病变患者疗效和预后。 方法 2013—2016年舟山市妇幼保健院共收治62例疑似消化道癌肿患者，其中，男性41例,女性21例，平均(58.5±6.2)岁。患者均经ESD进行诊断和治疗，术后病理结果确诊为早期癌前病变。考察ESD诊断和治疗的效果，并发症情况和患者的预后。 结果 病变均在黏膜、黏膜下层，部位分别在食管17例(27.42%)、胃29例(46.77%)、结肠16例(25.81%)，其中多为食管中段(10例,58.82%)。病理分型分别为Ⅰ型3例(4.84%)、Ⅱ型59例(95.16%)，其中多为Ⅱb (28例，47.16%)。病灶完全切除率为95.16%(59/62)，治愈性切除率为90.32%(56/62)。术中出血1例(1.61%)，穿孔2例(3.23%)，术后胸骨后疼痛2例(3.23%)，腹痛1例(1.61%)，均经抗感染、抑酸等治疗后痊愈。随访第6个月无失访患者，患者的进食不适、吞咽困难等症状均得到明显地缓解(分别为21例，33.87%和18例，29.03%)。复发1例(1.61%)，经再次ESD术后痊愈出院。 结论 ESD诊治消化道早期癌前病变的切除率高，并发症和术后复发率较低，可以作为微创诊疗消化道癌前病变的首选手段。 

Retrospective analysis of 62 cases of early precancerous lesions by diagnostic and therapeutic gastrointestinal endoscopies

Objective To evaluate the effect and outcome of endoscopic submucosal dissection(ESD) in the diagnosis and treatment of early gastrointestinal precancerous lesions. Methods From 2013 to 2016,62 cases of suspected gastrointestinal cancer patients in our hospital were enrolled into the study,including 41 cases of male and 21 cases of female.The average age was (58.5±6.2) years.All patients were diagnosed and treated by ESD,which were confirmed by pathological findings as early precancerous lesions.The effect of ESD in the diagnosis and treatment was evaluated;the complications and prognosis of patients were observed. Results The lesions were all located in the mucosa and submucosa.The lesions were located in esophagus(17 cases,27.42%),stomach(29 cases,46.77%) and colon(16 cases,25.81%),respectively.Most of them were middle esophagus(10 cases,58.82%).The pathological type Ⅰ was 4.84%(n=3) and type Ⅱ was 95.16%(n=59),in most of the patients it was of Ⅱb(28 cases,45.16%).The total resection rate was 95.16%(59/62),and the cure rate was 90.32%(56/62).The incidence of the complications was bleeding in 1 case(1.61%),perforation in 2 cases(3.23%),postoperative chest pain in 2 cases(3.23%),abdominal pain in 1 case(1.61%),they were all cured after anti-infection and antacid treatment.The sixth months follow-up showed that there was no lost patients,the patients with eating discomfort and dysphagia symptoms were obviously relieved(21 cases,33.87%;18 cases,29.03% respectively).Recurrence was found in 1 case(1.61%),and was cured after ESD. Conclusion ESD is effective in the diagnosis and treatment of early gastric precancerous lesions,with the low incidence of the complications and postoperative recurrence rate.It can be used as the first choice for minimally invasive diagnosis and treatment of precancerous lesions of digestive tract.