内镜下黏膜剥切术联合氩离子血浆凝固术治疗食管早期癌及癌前病变的价值

目的：探讨内镜下黏膜剥切术（EMR）联合氩离子血浆凝固术（APC）治疗食管早期癌及癌前病变的价值。方法：应用透明帽法对内镜下发现的食管早期癌或癌前病变的43例患者进行EMR治疗,并在窄带内镜（NBI）或碘染观察下对残留可疑病灶进行APC的灭活。术后1个月、2个月、半年、1年应用NBI技术进行内镜下随访。结果：42例行成功EMR或分次黏膜剥切术（EMRC）;1例患者因病灶行黏膜下注射时无法隆起,转外科手术;并发术中出血2例,均成功内镜下止血;2例食管狭窄,行内镜下扩张治疗;无一例出现穿孔。术后病理检查,9例示低级别上皮内瘤变,31例示高级别上皮内瘤变,2例示原位癌,1例示食管癌侵及黏膜下层。1例患者切除病灶病理示食管癌侵及黏膜下层而再行外科手术;随访1例患者2个月胃镜复查活检示中度不典型增生,再行内镜下APC治疗;1例患者半年胃镜复查活检示重度不典型增生,再次行内镜下EMR;余40例患者随访至今,最长已5年未出现复发。结论：EMR联合APC是治疗食管早期癌及癌前病变的安全有效的方法。

The Value of Endoscopic Mucosal Resectionand Argon Plasma Coagulation in Early Maligant Lesions and Squamous Premalignant of the Esophagus

Objective ： To approach the clinical value of endoscopic mucosal rescction（EMR） and argon plasma eoagulation（APC） to treat squamous premalignant and early malignant lesions of the esophagus. Methods ： Application of transparent cap on endoscopic findings of early esophageal cancer and precancerous lesions in 43 patients were treated with EMR, and in narrowband endoscopic（NBI） or iodine staining under observation on residual suspicious lesions were APC inactivation. All patients were followed up with NBI and endoscopy at 1 month, 2 month, 6 month and 12 month postoperation. Results ： From January 2007 to December 2011, endoscopic examination revealed 43 cases of early esophageal cancer and precancerous lesions in patients, including 42 cases of successful E MR or E MRC, 1 case of patients with submucosal injection of sickness stove row could not be raised, to surgical operation, complications of intraoperative hemorrhage in 2 cases, successful endoscopic hemostasis, 2 cases with esophageal stenosis, line endoscopic treatment of expansion, no case of perforation appeared. The postoperative pathology in 9 cases of pathological low-grade intraepithelial neoplasia, 31 cases showed high grade intraepithelial neoplasia and carcinoma in situ, 2 cases, 1 cases of esophageal carcinoma invading the pathological and submucosa. In one patient with resection of the lesion pathological esophageal carcinoma invading the submueosa and before the surgical operation, 1 case was followed up for 2 months to review patients with gastroscopy biopsy showed moderate dysplasia, endoscopic treatment in 1 patient with APC, half endoscopic review biopsy showed severe dysplasia, endoscopic EMR again, more than 40 patients so far the longest follow-up, 5 years had not relapse. Conclusion ： EMR with transparent cap-fitted endoscope combined with APC to treat early esophageal cancer and precancerous lesion of esophageal cancer is promising and safety method.