早期胃、食管癌内镜粘膜切除治疗研究

[目的]探讨内镜切除早期胃，食管癌的新方法及操作技巧。[方法]1996年9月-2001年7月采用自行设计，制作的套帽式内镜切除器，切除早期胃，食管癌39例，[结果]内镜切除早期癌39例中胃癌15例，食管癌24例，完全切除36例，完全切除率92.3%。随访4-5年8例，3-4年7例，余1-3年，未见复发，其他原因死亡2例，出血2例，未见穿孔。狭窄。[结论]该方法安全，有效，适应范围广；清晰显示病灶，准确套切，是完全切除的关键；注意粘膜下注药的量，掌握凝切的技巧可有效防止并发症。     

内镜套帽法切除食管胃早期癌及癌前病变89例分析

目的:探讨内镜套帽法切除早期食管、胃癌及癌前病变的应用价值.方法:1996年9月～2003年9月采用套帽法切除早期食管、胃癌及癌前病变89例,术前、术后均经病理证实.结果:随访5年以上17例,3～5年10例,1～3年38例,不足1年24例,非癌死亡5例,未见癌复发.结论:套帽法完全切除率较高,操作较简单,优于其他方法;病灶显示及切除技巧是影响完全切除的主要因素;适量粘膜下注药,掌握高频电切除技术等是预防并发症的关键;中度不典型增生短期复查无好转和重度不典型增生,应内镜治疗;内镜粘膜切除治疗在食管胃癌防治策略中具有重要价值和意义.     

内镜下黏膜剥离术治疗早期食管癌及癌前病变的临床应用

目的探讨内镜黏膜剥离术（ESD）在早期食管癌及癌前病变治疗中的应用价值与意义。方法选取2007年1月至2010年1月57例行内镜检查取活检经病理学确诊的早期食管癌及癌前病变并行ESD治疗的患者,进行内镜下黏膜剥离术,对照术前与术后的病理结果,并对手术并发症、治疗效果及预后进行观察。结果57例行ESD治疗的早期食管癌及癌前病变患者,术后病理学诊断黏膜内癌12例（21．1％）,原位癌22例（38．6％）,重度不典型增生18例（31．6％）,中度不典型增生5例（8．8％）。术前术后病理学诊断符合率为87．6％,其中有10例不相符的患者为术前活检病理级别低于术后病理级别。结论对于病理学活检、染色内镜及超声内镜确诊为直径〈30mm无肿瘤转移的早期食管癌及中重度异型增生患者进行内镜下黏膜切除术效果良好。黏膜下剥离术是这类早期食管癌及癌前病变治疗的有效方法,且创伤小,能有效提高患者术后生活质量,值得临床推广应用。     

放大内镜诊断早期食管癌及癌前病变的临床价值

目的探讨放大内镜诊断早期食管癌和癌前病变的临床价值。方法选取2011年6月至2013年5月收治的食管黏膜病变患者68例,行常规内镜检查,并选取同期体检健康者20例作为对照组。观察可疑病变部位上皮乳头内毛细血管袢(IPCL)的形态学改变,进行IPCL分型,通过组织活检进行病理学分析。结果放大内镜对食管癌范围和病变程度的诊断效果明显优于普通内镜(P<0.05)。正常对照组、食管炎、低级别癌变、高级别癌变和食管癌主要IPCL分型分别为Ⅰ型(100.0%)、Ⅱ型(85.1%)、Ⅲ型(50.0%)、Ⅲ型(60.0%)、Ⅳ型(66.7%)。结论放大内镜对早期食管癌及其癌前病变的诊断符合率较高,效果明显优于普通内镜,通过放大内镜IPCL形态学分型对早期食管癌及其癌前病变的诊断具有较高的临床价值。     

内镜下食管碘染在癌前病变及早期食管癌诊治中的应用价值

目的:探讨食管碘染色在食管癌前病变及早期食管癌诊治中的应用价值.方法:在2011年1月至2013年1月间对我科胃镜检查肉眼疑似微小和浅表粘膜病变者行食管碘染,阳性者行多点活检.结果:560例疑食管粘膜病变者碘染后有414例不染或浅染,碘染阳性者活检病理诊断食管癌25例、早癌10例、重度不典型增生63例、中度不典型增生31例、轻度不典型增生23例、炎症96例,检出率分别为6％、2.4％、15.2％、7.5％、5.6％、23.2％.23例碘染确定切除范围后行粘膜切除术患者,标本边缘均无病变累及.结论:食管碘染能提食管高早癌及癌前病变的诊断率,并可为内镜下食管粘膜切除及进展期食管癌外科切除确定手术范围提供参考,该方法值得在临床推广应用.     

管状胃法在食管癌和贲门癌根治术中的应用效果研究

目的研究管状胃法在食管癌和贲门癌根治术中的应用效果。方法选取2011年1月至2012年12月接受手术治疗的食管癌与贲门癌患者62例,按照食管重建方法分为观察组(31例)和对照组(31例)。两组患者一般资料比较,差异无统计学意义(P>0.05),观察组患者采取管状胃法治疗,对照组患者采取全胃缝缩治疗。结果两组患者手术成功率均为93.5%(P>0.05)。观察组和对照组患者手术后感染率分别为0和19.4%(P<0.05)。观察组和对照组患者手术后死亡率分别为0和12.9%(P>0.05),两组患者其他各项观察指标比较,差异无统计学意义(P>0.05)。结论食管癌和贲门癌采用管状胃法根治术,效果显著,值得在临床上推广应用。     

超声内镜相关技术在早期食管癌诊断中的应用

食管癌是临床上常见的恶性肿瘤之一,其发病率和死亡率一直居高不下,分期是其综合治疗及预后评估的主要依据。准确的分期对于适当的诊断、个体化治疗和良好的预后至关重要。超声内镜相关技术可以明确肿瘤浸润深度和局部淋巴结转移,使食管癌的诊断更为精确,在早期食管癌的诊断、治疗中发挥越来越重要的作用。     

食管癌和贲门癌354例外科治疗结果

本文报告食管癌和贲门癌３５４例的外科治疗结果。食管癌１２２例，贲门癌１２２例，贲门癌２３２例，共３５４例。食管癌、贲门癌切降率分别为８７．７％、８１．９％。切除术后发生并发症３１例，死亡８例，并发症发生率为１０．４％，切除手术死亡率为２．７％。食管癌、贲门癌切除术后五年生存率分别为２９．７％、２６．２％。作者对影响远期生存的因素及提高切除率问题进行了探讨。     

食管胃分层吻合法在食管癌切除的应用

食管胃分层吻合法在食管癌切除的应用洪永寿副主任医师黄文献，吴培仁，王希平，张文山漳州市医院（３６３０００）食管胃吻合术是食管瘤、贲门癌切除术后重建消化道最常见的方法，吻合口瘘及狭窄是食管胃吻合术后二个严重并发症，为了解决这二个并发症，各家采用不同的吻...     

食管癌贲门癌切除术后应用机械进行粘膜吻合434例报告

目的探讨预防食管胃吻合口瘘和吻合口狭窄的方法。方法使用吻合器进行食管粘膜和胃粘膜吻合。结果４４２例中,手工吻合８例,机械吻合４３４例,吻合成功率为９８．２％,术中失误率为２．３％,术后并发症发生率为９．３％,死亡率１．４％,未发生食管胃吻合口瘘和吻合口狭窄。结论食管粘膜和胃粘膜机械吻合操作简单、可靠,即可缩短手术时间,有效地预防食管胃吻合口瘘和吻合口狭窄的发生,又可以切除足够长度的食管,降低切缘残癌的发生率,是食管癌和贲门癌切除术中食管胃吻合的理想方法。     

Longterm outcomes after endoscopic mucosal resection for early gastric cancer

Background Despite the widespread use of endoscopic mucosal resection (EMR) in patients with early gastric cancer (EGC), its longterm outcomes have not been fully evaluated. Our aim was to evaluate longterm survival after complete EMR for EGC. Methods From patients who underwent EMR between 1978 and 1996 at our center, we enrolled 131 patients with differentiated mucosal EGCs less than 2 cm (without ulcerative change) that had been completely removed by EMR. The vital status of the patients at the end of December 1998 was confirmed by the hospital cancer registry, which is linked to the Osaka Cancer Registry. Results A total of 124 patients (95%) were completely followed-up. Two patients (1.5%) died of gastric cancer and 26 died of other causes during the mean observation period of 58 months. The overall 5- and 10-year survival rates were 84% and 64%, respectively. The disease-specific 5- and 10-year survival rates were 99% and 99%. Conclusion En bloc EMR ensured an excellent prognosis, and should be the first choice of treatment in patients with small differentiated mucosal EGC. Careful histological examination and longterm endoscopic surveillance are important.     

Adequate endoscopic mucosal resection for early gastric cancer obtained from the dissecting microscopic features of the resected specimens

Background. We have employed endoscopic mucosal resection (EMR), using a cap-fitted panendoscope (EMRC), for early gastric cancer since 1992. The presence of an adequate surgical margin is a requirement because of the radicality of EMR, and dissecting microscopic examination is useful in regard to the diagnosis of spread of the disease. Methods. To devise an adequate method of EMR that allows no lateral residue, we examined gastric mucosal specimens obtained by EMRC. One hundred and sixty-seven specimens from 97 lesions in 85 patients treated by EMRC were examined in regard to characteristic features, the recovery of marks made around the lesion, and the frequency of residue, and comparisons were made between the dissecting microscopic and histopathological findings. Results. The first specimen obtained with a large cap under full suction was a circular shape measuring 21 × 19 mm. The second specimen from fractionated resection was a half-moon or crescent shape, and the third specimen had a ginkgo leaf-like or irregular shape. In the elevated lesions, coincidence regarding the spread, as determined by dissecting microscopy and histopathology, was present in 62 (93%) of the 67 lesions. In 16 (53%) of 30 flat or depressed lesions, there was a difference of 2 to 5 mm between the spread determined by these two examinations. Conclusion. It is important to place an adequate number of marks around the lesion and recover all marks by resection. When an elevated lesion measures 15 mm or more, and a flat or depressed lesion is not clearly demarcated, aggressive use of planned fractionated resection seems to be the best way to prevent a lateral residue in EMR. Received: February 1, 2001 / Accepted: July 3, 2001     

Salvage radiation therapy for residual superficial esophageal cancer after endoscopic mucosal resection

PURPOSE: To analyze the outcomes of radiation therapy for patients with residual superficial esophageal cancer (rSEC) after endoscopic mucosal resection (EMR). METHODS AND MATERIALS: From May 1996 to October 2002, a total of 30 rSEC patients without lymph node metastasis received radiation therapy at Tohoku University Hospital and associated hospitals. The time interval from EMR to start of radiation therapy ranged from 9 to 73 days (median interval, 40 days). Radiation doses ranged from 60 Gy to 70 Gy (mean dose, 66 Gy). Chemotherapy was used in 9 of 30 patients (30%). RESULTS: The 2-year, 3-year, and 5-year overall survival rates and cause-specific survival rates were 91%, 82%, and 51%, respectively, and 95%, 85%, and 73%, respectively. The 2-year, 3-year, and 5-year local control rates for mucosal cancer were 91%, 91%, and 91%, respectively, and those for submucosal cancer were 89%, 89%, and 47%, respectively. These differences in survival rates for patients with two types of cancer were not statistically significant. Local recurrence and lymph node recurrence were more frequent in patients with submucosal cancer than in patients with mucosal cancer (p = 0.38 and p = 0.08, respectively). Esophageal stenosis that required balloon dilatation developed in 3 of the 30 patients, and radiation pneumonitis that required steroid therapy developed in 1 patient. CONCLUSIONS: Radiation therapy is useful for preventing local recurrence after incomplete EMR.     

A multicenter retrospective study of endoscopic resection for early gastric cancer

Background The reported outcomes of endoscopic resection (ER) for early gastric cancer (EGC) remain limited to several single-institution studies. Methods A multicenter retrospective study was conducted at 11 Japanese institutions concerning their results for ER, including conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Results A total of 714 EGCs (EMR, 411; ESD, 303) in 655 consecutive patients were treated from January to December 2001. Technically, 511 of the 714 (71.6%) lesions were resected in one piece. The rate of one-piece resection with ESD (92.7%; 281/303) was significantly higher compared with that for EMR (56.0%; 230/411). Histologically, curative resection was found in 474 (66.3%) lesions. The rate of curative resection with ESD (73.6%; 223/303) was significantly higher compared with that for EMR (61.1%; 251/411). Blood transfusion because of bleeding was required in only 1 patient (0.1%) with EMR of 714 lesions. Perforation was found in 16 (2.2%). The incidence of perforation with ESD (3.6%; 11/303) was significantly higher than that with EMR (1.2%; 5/411). All complications were managed endoscopically, and there was no procedure-related mortality. The median follow-up period was 3.2 years (range, 0.5–5.0 years). In total, the 3-year cumulative residual-free/recurrence-free rate and the 3-year overall survival rate were 94.4% and 99.2%, respectively. The 3-year cumulative residual-free/recurrence-free rate in the ESD group (97.6%) was significantly higher than that in the EMR group (92.5%). Conclusion ER leads to an excellent 3-year survival in clinical practice and could be a possible standard treatment for EGC. ESD has the advantage of achieving one-piece resection and reducing local residual or recurrent tumor.     

从高发现场视角看食管癌和贲门癌的临床研究趋势

我院流行病室开展食管癌和贲门癌高发现场研究已历30余年,所取得的最显著成绩主要有以下4个方面：（1）对食管癌癌前病变（即鳞状上皮不典型增生）及其逐级发展和演变规律的确认,以及对各级不典型增生诊断及处理的经验;（2）对食管癌早诊早治方法的探索,以及实践所得的优异效果;（3）食管鳞状细胞癌易发部位的发现及其对食管癌早期诊断的贡献;（4）胃贲门癌高发位点的发现及其对贲门癌早诊早治的贡献。在此基础上,结合我们长期在高发现场的实际工作经验,展望今后食管癌和贲门癌临床研究的趋势。     

行根治术治疗食管癌和贲门癌患者的预后分析

目的 探讨食管癌和贲门癌患者行根治术治疗后的预后影响因素.方法 回顾性分析906例行根治术治疗的食管癌和贲门癌患者的临床资料,选择12个可能对患者预后产生影响的特征性临床病理因素,运用Cox比例风险模型进行预后分析.结果 906例患者的1、3、5年累积生存率分别为89.8%、75.4%和71.7%.单因素分析结果显示,年龄、病理类型、病变长度、淋巴结转移数、临床分期、浸润深度、周围器官受侵情况与行根治手术治疗的食管癌和贲门癌患者的预后有关.Cox比例风险模型多因素分析结果显示,病理类型、临床分期、淋巴结转移数、周围器官受侵情况为行根治手术治疗的食管癌和贲门癌患者预后的独立影响因素.结论 病理类型、临床分期、淋巴结转移数、周围器官受侵情况为行根治手术治疗的食管癌和贲门癌患者预后的独立影响因素,临床医师在实际工作中可以参考借鉴.     

Efficacy and safety of grasping forceps-assisted endoscopic resection for gastric neoplasms: A multi-centre retrospective study

BACKGROUNDEndoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC) without lymph node metastasis, although ESD is challenging, even for small lesions, in the greater curvature (GC) of the upper (U) and middle (M) thirds of the stomach. Grasping forceps-assisted endoscopic resection (GF-ER) is a type of endoscopic mucosal resection that is performed via a double-channel endoscope. AIMTo investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach’s U and M regions.METHODSWe retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach’s U and M regions in three institutions between January 2016 and May 2020. Nine lesions from eight patients who underwent GF-ER for EGC (the GF-ER group) were compared to 63 lesions from 63 patients who underwent ESD (the ESD group). We also performed a subgroup analysis of small lesions (≤ 10 mm) in 6 patients (7 lesions) from the GF-ER group and 20 patients (20 lesions) from the ESD group. RESULTSThere were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates (100% vs 100%) and the R0 resection rates (100% vs 98.4%). The median procedure time in the GF-ER group was shorter than that in the ESD group (4.0 min vs 55.0 min, P < 0.01). There were no adverse events in the GF-ER group, although five perforations (8.0%) and 1 case of postoperative bleeding (1.6%) were observed in the ESD group. When we only considered lesions that were ≤ 10 mm, the median procedure time in the GF-ER group was still shorter than that in the ESD group (4.0 min vs 35.0 min, P < 0.01). There were no adverse events in the GF-ER group, although 1 case of perforation (1.6%) were observed in the ESD group.CONCLUSIONThese findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach’s U and M regions.     

Initial radiographic findings of early gastric cancer detected in health check programs and human "dry dock" collective health checks and treated by endoscopic mucosal resection

Abstract. Background: The purpose of this study was to evaluate the capacity of detection (detectability), by radiographic examination, of minute gastric cancer that was indicated for endoscopic mucosal resection (EMR). Methods: Fifty-five lesions in 55 patients with minute gastric cancer were endoscopically resected between 1992 and 2000 at the Foundation for Detection of Early Gastric Carcinoma. Of these 55 patients, 33 patients underwent indirect (with image intensifier and 100-mm roll film) and/or direct radiographic examination of the upper gastrointestinal tract as the initial screening examination, and subsequent upper gastrointestinal endoscopy. The remaining 22 patients underwent upper gastrointestinal endoscopy as the initial screening examination. As the first step, radiographic (indirect and direct) images were reviewed, and the abnormalities which had eventually led to the detection of the minute early gastric cancer (EGC) were reconfirmed. Then, they were analyzed in terms of the reproducibility of abnormal findings which enabled the detection of such a minute EGC, and in terms of whether they could be treated by EMR. The size, morphology, and location of the radiographically detected lesions were analyzed. Results: Seventeen lesions of EGC were detected in the group in which indirect radiography was initially performed. Of these 17 lesions, some abnormality corresponding to the site of the lesion was pointed out in 7 lesions (2 lesions of type IIa and 5 lesions of type IIc). On the other hand, the remaining 10 lesions (type IIa, 3; type IIc, 5; type IIa + IIc, 1; and type IIb, 1) were detected by endoscopy, which was carried out to confirm the other abnormalities in the indirect radiographic images. Sixteen lesions of EGC were detected in the group in which direct radiography was initially performed. Of these 16 lesions, some abnormality corresponding to the site of the lesion was pointed out in 8 lesions (4 lesions of type IIa and 4 lesions of type IIc). The remaining 8 lesions (3 lesions of type IIa and 5 lesions of type IIc) were not detected by direct radiography. Conclusion: Indirect and direct radiographic examination enabled the detection of approximately 50% of EGCs which could be treated by endoscopic resection. The significance of radiographic examination should not be underestimated, even in the detection of EGCs which can be endoscopically resected. Received: June 18, 2001 / Accepted: December 7, 2001     

Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?

Background Endoscopic resection (ER) has been widely accepted in Japan as a less invasive treatment for early gastric cancer, but the incidence of subsequent metachronous gastric cancer (MGC) and the appropriate endoscopic follow-up interval after ER have not been determined as yet. In this study, we investigated the incidence of MGC after ER and assessed our annual endoscopic surveillance program after ER. Methods We studied the clinicopathological features of 633 consecutive ER patients (575 with a single lesion and 58 with synchronous multiple lesions) treated at our institution from 1987 through 2002, after excluding 158 patients who underwent additional surgery due to noncurative ERs, 180 patients whose surveillance periods were less than 1 year, 1 patient with hereditary non-polyposis colorectal cancer, and 1 patient with gastric tube cancer. We defined a second cancer found within 1 year after ER as “synchronous” and a second cancer found after 1 year as “metachronous.” Results First MGCs had an overall incidence of 8.2% (52 out of 633 patients); the annual incidence was constant, and the cumulative 3-year incidence was 5.9%. The average time to the discovery of a first MGC after the initial ER was 3.1 ± 1.7 years (range, 1–8.6 years). Almost all first MGCs (96.2%, 50 out of 52 lesions) were treated curatively with repeat ER. Conclusion In order to detect MGC at a stage early enough for a curative repeat ER, an annual endoscopic surveillance program is both practical and effective for post-ER patients.