内镜黏膜下剥离术治疗食管早期癌及癌前病变

目的 探讨内镜黏膜下剥离术(ESD)治疗食管早期癌及癌前病变的应用价值.方法 对胃镜发现的食管早癌和上皮内瘤变、深度未超越黏膜卜层者15例进行ESD治疗:(1)黏膜下注射生理盐水抬高病变;(2)预切开病变周围黏膜;(3)沿病变下方黏膜下层完整剥离病变.结果 15例食管早癌和上皮内瘤变病变,最大卣径2.5～4.5 cm(平均3.2 cm).14例病变成功完成ESD治疗,ESD成功率93.3%(14/15).所有剥离病变全部得到病理确诊,基底和切缘未见病变累及.ESD手术时间(白黏膜下注射至完整剥离病变)45～150 min,(平均75 min).术中出血量平均30 ml,均经电凝、氙离子凝固术和止血夹成功止血,未出现需再次内镜下治疗的出血;ESD穿孔发生率0(0/15).术后随访14例,随访期6～18个月(平均11.5个月),创而完全愈合,无一例病变残留和复发.结论 ESD是治疗食管早癌和癌前病变的新方法,不仅能完整切除较大的病变,还能提供完整的病理学诊断资料.

Endoscopic submucosal dissection for early esophageal carcinomas and pre-malignant lesions

Objective To assess the clinical application of endoscopic submucosal dissection(ESD) for early esophageal carcinomas and pre-malignant lesions. Methods ESD was performed for early esophageal carcinomas and intraepithelial neoplasms without submucosal infiltration. First, normal saline was injected into the submucosa to elevate the lesion from the muscle layer. Then, the surrounding mucosa of the lesion were cut, and the lesion was dissected along the connective tissue of the submucosa. Results Of 15 early esophageal carcinomas and intraepithelial neoplasms, ranging from 2.5 to 4.5 cm (mean size 3.2 cm) , 14 (93.3%) underwent ESD successfully . All 14 lesions were confirmed pathologically, and no basal or dissected margin was involved. The mean ESD procedure time (from fluid injection to complete dissection) was 75 min ( ranging from 45 to 150 min). Minor bleeding (mean volume 30 ml) occurred in all lesions, which was stopped by electric coagulation, argon plasma coagulation and clamps. No delayed bleeding occurred. The perforation rate of ESD was 0(0/15). Fourteen patients were followed up after ESD for 6 to 18 months (mean=11.5), and healed with no residue or recurrence. Conclusion ESD is a novel endoscopic procedure to reseet early esophageal carcinomas and pre-malignant lesions, with which large lesions can be resected and pathological information can be provided.