中国实用外科杂志

中国实用外科杂志

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内镜黏膜下剥离术治疗相对适应证老年早期食管鳞癌69例疗效分析

李    冰，齐志鹏，周平红，姚礼庆，徐美东，任    重，时    强，陈    涛，蔡世伦，钟芸诗   

  1. 复旦大学附属中山医院内镜中心 上海消化内镜诊疗工程技术研究中心，上海 200032
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    评价内镜黏膜下剥离术（ESD）治疗相对适应证老年（年龄≥60岁）早期食管鳞癌病人的安全性、有效性和长期生存情况。方法    回顾性分析2008年1月至2013年12月复旦大学附属中山医院内镜中心行ESD治疗早期食管鳞癌病人的临床资料，筛选出其中符合日本食管学会（JES）食管癌诊治指南内镜治疗相对适应证且术后无追加治疗的老年病人共69例，观察并分析术后并发症以及长期生存情况。结果    62例（89.9%）病人侵犯至黏膜肌层（M3），7例（10.1%）侵犯至黏膜下层<200 μm（SM1），6例（8.7%）存在淋巴管浸润。术后1例（1.4%）病人发生出血，经内镜下治疗后止血；2例（2.9%）穿孔经内镜缝合后闭合；22例（31.8%）发生食管狭窄。术后复发率为11.6%（8/69），中位复发时间为24个月。1例病人出现肝和淋巴结转移。5年无病存活率为86.2%；有4例（5.8%）病人死亡，5年总体存活率为90.0%，中位生存时间为56个月。结论    ESD治疗相对适应证老年早期食管鳞癌病人，不进行追加治疗也可能获得较好的长期生存，并且安全性和有效性较高。

关键词: 内镜黏膜下剥离术, 早期食管鳞癌, 相对适应证, 老年病人

Abstract:

Outcomes evaluation of endoscopic submucosal dissection for relative indication group of early esophageal squamous cell carcinoma in aged patients: An analysis of 69 cases        LI Bing，QI Zhi-peng，ZHOU Ping-hong，et al. Endoscopy Center and Endoscopy Research Institute，Zhongshan Hospital，Fudan University，Shanghai 200032，China
Corresponding author：ZHONG Yun-shi，E-mail：zhong.yunshi@zs-hospital.sh.cn
Abstract    Objective    To evaluate the safety，efficacy and long-term outcomes of endoscopic submucosal dissection (ESD) for relative indication group of early esophageal squamous cell carcinoma in aged patients. Methods    The clinical data of early esophageal squamous cell carcinoma treated by ESD from January 2008 to December 2013 in the Endoscopy Center of Zhongshan Hospital, Fudan University were analyzed retrospectively. A total of 69 cases of elderly patients were with the relative indications from the part of endoscopic treatment of Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society and no additional treatment were picked out. The incidence of complications and long-term outcomes were observed and analyzed. Results    62 (89.9%) cases were infiltrated to muscularis muscular (M3)；7 (10.1%) cases were infiltrated into submucosal within 200 μm (SM1); 6 (8.7%) cases were lymphatic infiltration. There were 1 (1.4%) case with postoperative bleeding who underwent endoscopic hemostatic procedures after the ESD，2 (2.9%) cases with perforation who underwent the endoscopic suturing closure and 22 (31.8%) cases with esophageal stricture after operation. The recurrence rate was 11.6% (8/69) and the median recurrence time was 24 months. Liver and lymph node metastasis were existed in 1 case. As a result，the 5-year disease-free survival rate was 86.2%. The 5-year overall survival rate was 90.0% in the case of 4 patients (5.8%) died，and the median survival time was 56 months. Conclusion    ESD could achieve comparatively ideal long-term outcomes in the treatment of early esophageal squamous cell carcinoma of aged patients without additional treatment, which has high safety and effectiveness.

Key words: endoscopic submucosal dissection, early esophageal squamous cell carcinoma, relative indication, aged patients