食管黏膜病变内镜黏膜下剥离术前和术后的临床病理分析

Clinicopathological analysis of endoscopic submucosal dissection for esophageal mucosa lesion

摘要:

目的 回顾性分析早期食管癌和癌前病变的内镜下特征及临床病理特征，探讨内镜黏膜下剥离术 （ESD）治疗的必要性、安全性和有效性。方法 纳入2013 年5 月-2016 年4 月经白光内镜及病理活检诊断 为早期食管癌及上皮内瘤变的患者51 例，分析毛细血管袢（IPCL）、碘染色、术前术后病理结果及相关并发 症的发生情况。结果 51 例患者共58 处病变，IPCL 分类58 处病变中A 型8 处（13.79%），B1 型44 处（75.86%）， B2 型6 处（10.34%）；术前活检结果11 处（18.97%）为低级别上皮内瘤变（LGIN），42 处（72.41%）为高级 别上皮内瘤变（HGIN），5 处（8.62%）为鳞状细胞癌，术后病理结果10 处（17.54%）病变为LGIN，27 处（46.55%） 为HGIN，21 处（36.21%）病变为鳞状细胞癌，术前术后病理结果符合率为60.34%。微穿孔、狭窄和术后迟 发性出血的概率分别为0.00%（0/58）、8.62%（5/58）和3.45%（2/58）。结论 ESD 术后食管早癌的检出率显 著增加，术前活检对诊断和治疗有指导意义，ESD 治疗能减少食管早癌的漏诊。

Abstract:

Objective To analyze the endoscopic and clinicopathologic features of early esopheal carcinoma and precancerous lesions and evaluate the necessity, efficacy and safety of ESD in the treatment. Methods From May 2013 to April 2016, 51 consecutive patients underwent high-resolution video endoscopy and biopsy, confirmed diagnosis of early esophageal squamous cell carcinoma or intraepithelial neoplasia were included. There were capillary loops (IPCL), iodine-staining, preoperative and postoperative pathology, and complications to analyze. Results 51 patients had total 58 lesions, Type A, Type B1, Type B2 of IPCL classification were diagnosed in 8 (13.79%), 44 (75.86%), 6 (10.34%). low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of preoperative biopsy were diagnosed in 11 (18.97%), 42 (72.41%), 5 (8.62%), low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia, early esophageal carcinoma of postoperative pathology results were diagnosed in 10 (17.54%), 27 (46.55%), 21 (36.21%), concordance rate of pathological results were 60.34%. Complications included micro-perforations (0.00%), strictures (8.62%) and delayed hemorrhage (3.51%), respectively. Conclusion After endoscopic submucosal dissection, detection rate of early esophageal cancer increased significantly, preoperative biopsy had guidance significance in diagnosis and treatment, ESD treatment can reduce the missed diagnosis of early esophageal carcinoma.