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同时性多原发早期食管癌及癌前病变安全性和有效性分析

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

  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:2018-07-01 发布日期:2018-07-09

  • Online:2018-07-01 Published:2018-07-09

摘要：

目的    分析内镜黏膜下剥离术（ESD）治疗同时性多原发早期食管癌及癌前病变的安全性和有效性。方法    回顾性分析2014-06-01至2016-12-31复旦大学附属中山医院内镜中心行ESD治疗的25例同时性多原发早期食管癌及癌前病变病人的临床资料，包括病灶大小、病理学检查结果、整块切除率、治愈性切除率、并发症及复发情况等。结果    22例病人同期切除多个病灶，3例病人分次切除病灶，其中1例病人6个月内分次切除4个病灶，每次2个。共切除54个病灶，切除标本49块，其中5块标本上有2个病灶。整块切除率100%，治愈性切除率为87%（47/54）。术后1例病人食管穿孔，2例食管狭窄，无其他并发症。2例病人接受术后放疗，2例病人同时接受术后放疗和化疗，1例病人追加传统外科手术治疗。中位随访时间为19.4（8.6~43.8）个月，1例病人局部复发，无手术相关性死亡，无淋巴结及远处转移。结论    ESD用于同时性多原发早期食管癌及癌前病变的治疗安全有效。对于早期食管癌病人行胃镜检查时，应格外警惕食管多原发病灶的可能。

关键词: 内镜黏膜下剥离术, 同时性多原发癌, 早期食管癌, 癌前病变

Abstract:

Efficacy and safety of endoscopic submucosal dissection for synchronous multiple primary early esophageal cancer and premalignant lesions        SUN Di，SHI Qiang，XU Mei-dong，et al.  Endoscopy Center，Zhongshan Hospital，Fudan University；Shanghai Center of Engineering Technology，Diagnosis and Treatment in Endoscopy，Shanghai 200032，China
Corresponding author：ZHONG Yun-shi，E-mail：zhong.yunshi@zs-hospital.sh.cn
Abstract    Objective    To evaluate the efficacy and safety of ESD for synchronous multiple primary early esophageal carcinomas and premalignant lesions. Methods    The medical records of 25 patients who underwent ESD for synchronous multiple primary early esophageal carcinomas and premalignant lesions at Endoscopy Center of Zhongshan Hospital，Fudan University between June 1, 2014 to December 31, 2016 were analyzed retrospectively. The data of lesion size，histopathology，completeness of resection，adverse events and tumor recurrence were analyzed. Results    Among 25 patients，lesions were removed at the same time in 22 cases. Lesions were removed separately in 3 cases while 2 lesions were removed separately and in another case，4 lesions were removed in twice，2 lesions each time. Totally 54 lesions were removed and 49 specimens were achieved，5 of which had 2 lesions on. The en blot resection rate was 100% and the complete resection rate was 87% (47/54). Postoperative esophageal perforation occurred in 1 case and postoperative esophageal stricture occurred 2 cases. Two patients received postoperative radiotherapy, 2 patients received postoperative radiotherapy and chemotherapy, and 1 patients received surgery. The median follow-up time was 19.4 (8.6-43.8) months. There was 1 local recurrence，no metastasis or procedure-related death. Conclusion ESD is effective and safe treatment for synchronous multiple primary early esophageal cancer and premalignant lesions. When checking for the esophagus，multiple esophageal cancer need to be paid extraordinary attention.

Key words: endoscopic submucosal dissection, synchronous multiple primary esophageal cancer, early esophageal cancer, premalignant lesions