内镜下黏膜下剥离术治疗69例食管早癌及癌前病变的价值及术后病理分析

Clinical value and postoperative pathological analysis in early esophageal carcinoma and intraepithelial neoplasia treated by endoscopic submucosal dissection

摘要:

目的 探讨内镜黏膜下剥离术（ESD）治疗食管早癌及癌前病变的临床疗效，并分析手术前后标本病理特点。方法 69例研究对象术前经胃镜活检标本检查确诊为早期食管癌或食管癌前病变，均经ESD治疗，观察其临床特征、并发症、病灶大小、术前及术后病理特点等。结果 手术整块切除率100.00%（69/69），完整切除率95.65%（66/69），治愈性切除率95.65%（66/69）。切除标本最大直径7.0 cm。术前钳取活检总正确率为69.57% （48/69），与活检相比，手术标本诊断更准确。结论 ESD是治疗食管早癌及癌前病变的有效方法。ESD可一次性完全切除病灶，且可以提供完整标本进行进一步病理学评估，以提高病理的正确诊断率。

Abstract:

Objective To evaluate the effect and pathological characters for patients with early esophageal carcinoma and intraepithelial neoplasia after endoscopic submucosal dissection (ESD). Methods 69 patients from January 2013 to January 2016 were treated with ESD at the early stage of esophageal carcinoma and intraepithelial neoplasia. The clinical features and the size of the lesions of all the patients were collected. Then analyzed postoperative complications and pathological characteristics. Results Among 69 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The whole piece resection rate was 100.00 % (69/69), complete resection rate and curative resection rate was 95.65 % (66/69), respectively. The largest removal diameter is 7.0 cm. Biopsy accuracy was 69.57 % (48/69). Compared with biopsy, diagnostic accuracy with ESD specimens is higher. Conclusion The early esophageal carcinoma and intraepithelial neoplasia can be treated with ESD. ESD can resect lesions primarily, provide complete specimen for further pathological assessment and improve diagnostic accuracy.