内镜下分片黏膜切除术治疗早期食管癌及癌前病变

目的评价内镜下分片黏膜切除术(endoscopy piecemeal mucosal resection,EPMR)对早期食管癌及癌前病变治疗的可行性及疗效。方法 2005年1月～2011年1月,应用EPMR治疗110例111处病灶,病灶直径2～10 cm。黏膜下注射肾上腺素-亚甲蓝溶液,病灶充分抬举后,使用透明帽法对病灶进行分片切除。结果上皮内瘤变92处,早期食管癌19处。完全切除96处(86.5%),不完全切除15处(13.5%)。出血率5.4%(6/111),穿孔率6.3%(7/111),不同病变直径、切除标本数量、病变环周范围的出血、穿孔发生率差异无显著性(P>0.05)。食管狭窄8例(7.2%),病变范围>1/3周、标本≥5片的狭窄率更高[病变范围>1/3周vs.≤1/3周:18.2%(6/33)vs.2.6%(2/78),χ2=6.283,P=0.012;标本≥5片vs.2～4片:15.8%(6/38)vs.2.7%(2/73),χ2=4.562,P=0.033]。110例随访6周～5年1个月,其中58例>2年。17处病灶复发(15.3%)。不完全切除、病灶范围>1/3周、标本≥5片的局部复发率更高[不完全切除vs.完全切除:40.0%(6/15)vs.11.5%(11/96),χ2=6.096,P=0.014;病变范围>1/3周vs.≤1/3周:30.3%(10/33)vs.9.0%(7/78),χ2=8.134,P=0.004;标本≥5片vs.2～4片:28.9%(11/38)vs.8.2%(6/73),χ2=8.279,P=0.004]。结论 EPMR适用于食管癌前病变的治疗,对早期食管癌需进一步验证。

Endoscopic Piecemeal Mucosal Resection for Early Esophageal Cancers and Precancerous Lesions

Objective To evaluate the feasibility and the outcome of endoscopic piecemeal mucosal resection(EPMR) for early esophageal cancers and precancerous lesions. Methods Totally 110 patients with 111 lesions of early esophageal cancer or precancer(diameter,2-10 cm),who were admitted to our hospital between January 2005 and January 2011,received EPMR.After submucosal injection of saline-epinephrine solution and lifting up the lesion,we used EMRC to remove the lesions. Results In the 111 lesions,96(86.5%) were removed completely,and the other 15(13.5%) were resected incompletely;6 of the patients(5.4%) had hemorrhage,and 7(6.3%) developed perforation.No significant difference existed in the rates of perforation and hemorrhage among different diameters of the lesions or the cases with different numbers of removed pieces(P>0.05).After the operation,8 patients(7.2%) developed esophageal stenosis,in the patients who had the range of the lesion larger than 1/3 circumference of the esophagus or removed pieces of the lesion ≥ 5 showed significantly higher rate of stenosis [range of the lesion >1/3 vs.≤ 1/3 circumference of the esophagus: 18.2%(6/33) vs.2.6%(2/78,χ2=6.283,P=0.012;removed lesion ≥ 5 pieces vs.2-4 pieces: 15.8%(6/38) vs.2.7%(2/73),χ2=4.562,P=0.033].We followed up the patients for 6 weeks to 5 years and 1 month(> 2 years in 58 cases),during which,recurrence occurred in 17 lesions(15.3%).The rate of local recurrence was significantly higher in the patients with incomplete resection,the range of the lesion larger than 1/3 circumference of the esophagus,and removed lesions ≥ 5 pieces [ incomplete resection vs.complete resection:40.0%(6/15) vs.11.5%(11/96),χ2=6.096,P=0.014;range of the lesion > 1/3 vs.≤ 1/3 circumference of the esophagus:30.3%(10/33) vs.9.0%(7/78),χ2=8.134,P=0.004;removed lesions ≥ 5 pieces vs.2-4 pieces: 28.9%(11/38) vs.8.2%(6/73),χ2=8.279,P=0.004].Conclusion EPMR is effective for precancerous esophageal lesions,further studies are needed on its efficacy for early esophageal cancers.