内镜下黏膜切除术联合氩离子血浆凝固术治疗早期食管癌及其癌前病变

目的]探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）联合氩离子血浆凝固术（Argon plasma coagulation,APC）在食管癌高发区治疗早期食管癌及其癌前病变的意义。方法]应用透明帽法对食管癌高发区普查中发现的84例早期食管癌及食管癌前病变行EMR治疗,并联合应用APC治疗残留及复发病灶。术后2、6个月进行内镜复查。结果]2004～2008年间共有84例患者成功行EMR,治疗成功率为100%。并发症：术中出血3例,术后出血2例,经内镜下治疗或保守治疗均成功止血;无一例穿孔、狭窄等并发症发生。随访：84例中,5例早期食管癌,49例原位癌/重度不典型增生术后半年随访时对原切除部位行内镜下活检,病理诊断5例重度不典型增生、8例中度不典型增生和19例轻度不典型增生,均内镜下APC治疗。平均随访21个月,无一例复发。结论]应用透明帽法内镜下黏膜切除联合氩离子凝固术治疗早期食管癌及其癌前病变是食管癌二级预防的有效方法。

Endoscopic Mucosal Resection Combined with Argon Plasma Coagulation in the Treatment of Early Esophageal Cancer and Precancerous Lesion

Purpose ] To evaluate the effect of endoscopic esophageal mucosal resection （EMR） combined with Argon plasma coagulation （APC） in the treatment of early stage esophageal cancer and precancerous lesion of esophageal cancer in the high incidence area of esophageal cancer. Methods] Endoscopic esophageal mucosal resection were performed with transparent-cap tech- nique on 84 cases with early esophageal squamous cell carcinoma or precancerous lesions, the residual lesions were treated by APC. All patients were followed up with endoscopy at 2 month, and 6 month postoperation. Results] From 2004 to 2008, 84 cases were treated with EMR and the success rate is 100%. Complication was found in 3 cases with intraoperative bleeding during EMR; 2 cases with postoperative bleeding with EMR. All the complications were controlled suc- cessfully by endoscopic and conservative treatment. No case suffered from perforation or stenosis. Follow-up： 5 cases with early esophageal squamous carcinoma and 49 cases with carcinoma in site or sever dysplasia were biopsied at 6 month after EMR, the residual lesions were found in 5 cases with sever dysplasia; 8 cases, middle dysplasia, and 6 cases, mild dysplasia. All residual lesions were treated by APC. All cases survived without recurrence after a follow-up period of 21 months on average. Conclusion I EMR with transparent cap-fitted endoscope combined with APC to treat early esophageal cancer and precancerous lesion of esophageal cancer is promising method to pre- vent the development of esophageal cancer.