内镜切除治疗在早期食管癌和贲门癌及其癌前病变中的应用价值

目的 评价内镜套帽法切除早期食管癌、贲门癌及癌前病变的长期疗效和应用价值.方法 采用内镜套帽法切除早期食管癌、贲门癌及癌前病变147例(154个病灶),其中早期食管癌64例(69个病灶),癌前病变45例(47个病灶),病灶直径3～40 nm,平均(14.8±6.1)mm;早期贲门癌23例,癌前病变15例(均为单灶),病灶直径5～25 mm,平均(8.2±4.3)mm.全组病例均经病理证实.结果 全组有139个病灶被完全切除,完全切除率为90.3%.食管和贲门病灶的完全切除率均与病灶大小有关,病灶越大,完全切除率越低(P=0.001和P=0.014).147例患者中,内镜随访不足3年者66例,3～5年者31例,5～10年者43例,10年以上者7例.全组死亡11例,其中肿瘤复发死亡1例.早期食管癌和贲门痈的5年生存率分别为96.2%和100.0%.本组有5例(3.4%)患者发生术中出血,1例(0.7%)患者发生狭窄,无穿孔发生.结论 内镜黏膜切除治疗早期食管癌和贲门癌,符合其生物学特点,可达到传统手术治疗相同的长期疗效,亦适用于重度不典型增生的治疗.

The value of endoscopic mucosal resection for dysplasia and early-stage cancer of the esophagus and gastric cardia

Objective To evaluate the long.term effect and clinical value of endoscopic mucosal resection(EMR)with transparent cap for dysplasia and early-stage cancer of the esophagus and gastric cardia.Methods From September 1996 to June 2007.154 lesions in the esophagus or gastric cardia of 147 patients were treated using EMR with transparent cap.Among thse lesions,there were 69 early-stage squamous-cell carcinomas in 64 patients and 47 squamous cell precancerous lesions of the esophagus in 45 patients,with an average lesion size of(14.8±6.1)am(range,3～40 mm),furthermore,there were 23 early-stage adenocarcinomas in 23 patients and 15 precancerous lesions in the gastric cardia in 15 patients.with an average lesion size of(8.2±4.3)mm(rang,5～25 mm).All lesions were finally confirmed histopathologically.Results of the 154 lesions,139(90.3%)were resected completely through EMR procedure.A close relationship between the complete resection rate and the lesion size was observed.The bigger the lesion size,the lower the complete resection rate.Endoscopic follow.up was carriecl out in 7 patients for more than 10 years,in 43 for 5-10 years,in 3l for 3-5 years and in 66 for less than 3 years.Of 11 dead patients during following-up,10 died of other diseases,only 1 of recurrence.The 5-year survival rate was 96.2%for early-stage esophageal cancer.and 100%for early cancer of the gastric cardia.Perioperative complications included oozing bleeding in 5 patients(3.4%)and stricture in 1(0.7%),no perforation occurred in this series.Conclusion Endoscopic mucosal resection is suitable to treat precancerous lesions or early-stage esophageal cancers without invasion into submucosa.Compared with conventional resection throuIgh open thoracotomy.similar long-term sunrival and curative effect can be achieved by this EMR treatment,preserving a good quality of life.