内镜黏膜下剥离术治疗食管早癌及癌前病变384例临床分析

目的 观察内镜黏膜下剥离术(endoscopic submucosal dissection,ESD) 对食管早癌及癌前病变的临床疗效,探讨ESD在食管早癌及癌前病变治疗中的应用价值.方法 以2011年8月至2016年12月在本院消化内镜中心接受ESD治疗的384例食管早癌及癌前病变患者为研究对象,回顾性综合评价其临床治疗效果.结果 完成ESD治疗的食管早癌及癌前病变患者384例,中位随访时间26(6 ～68) 个月,平均切除面积12.0(7.4～20.0) cm2,平均手术时间40.0(30.0～63.8) min,整块切除率、完全切除率、治愈性切除率分别为: 98.96％(380/384) 、96.35％(370/384) 、92.45％(355/384);出血、穿孔、狭窄发生率分别为1.56％ (6/384) 、0.26％ (1/384) 、13.80％ (53/384);Logistic回归分析结果 显示,病变环周比例≥2/3OR = 63.370(14.579～275.448) ,P＜ 0.01]是食管狭窄发生的独立危险因素.3年整体生存率、肿瘤特异性生存率分别为96.30％、100％,病变复发率2.86％(11/384) .结论 ESD治疗食管早癌及癌前病变安全、有效.

Clinical evaluation of endoscopic submucosal dissection for patients with early esophageal cancer and precancerous lesion: report of 384 cases

Objective To investigate the clinical efficacy of endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions and explore its application in the treatment. Methods A total of 384 consecutive patients who underwent ESD due to early esophageal cancer and precancerous lesions in our endoscopic center from August 2011 to December 2016 were enrolled in this study. A retrospective analysis was performed to evaluate the efficacy of the approach. Results All the 384 patients with early esophageal cancer or dysplasia completed ESD, and were followed up for a median time of 26 (6 ～68) months. Their average dissection area was 12.0 (7.4 ～ 20.0) cm2, and the mean procedure time was 40.0 (30.0 ～ 63.8) min. The overall en bloc resection rate was 98.96％ (380/384), the complete resection rate 96.35％ (370/384), and the histologically complete resection rate 92.45％ (355/384). The incidence rate of bleeding, perforation, and esophageal stricture was 1.56％ (6/384), 0.26％ (1/384), and 13.80％ (53/384) respectively. Logistic regression analysis results showed that circumference of the lumen≥2/3OR = 63.370(14.579 ～ 275.448), P＜0.01]was an independent risk factor for esophageal stricture. The post-treatment 3-year overall survival rate was 96.30％, the cause specific survival rate was 100％, whereas, the local recurrence rate was 2.86％ (11/384). Conclusion ESD is a safe and effective approach in treatment of early esophageal cancer and precancerous lesions.