内镜下多环黏膜套扎切除术治疗食管癌前病变和食管早癌的疗效及安全性分析*

Efficacy and safety of endoscopic multi-band mucosectomy in treatment of esophageal precancerous lesions and early esophageal cancer*

摘要:

摘要：目的 探讨内镜下多环黏膜套扎切除术（EMBM）治疗食管癌前病变和食管早癌的疗效及其安全性。方法 回顾性分析2013年1月－2016年6月在该院内镜中心接受EMBM治疗的75例食管癌前病变和食管早癌患者，观察记录手术时间、手术并发症和治疗效果，对比术前和术后病理结果，并结合随访结果，分析总结EMBM的疗效。结果 75例患者均顺利完成EMBM术，手术时间（40.00±9.21）min，3例术中并发出血，均成功内镜下止血，无穿孔、迟发性出血和操作相关死亡发生。9例患者术后出现食管创面狭窄，予以内镜下球囊扩张后狭窄缓解。EMBM术后病理：低级别上皮内瘤变（LGIN）24处，高级别上皮内瘤变（HGIN）45处，黏膜内癌（IMCA）9处，所有患者水平切缘均阴性。相比较EMBM前的钳夹活检，有21处（26.9%）标本病理结果发生变化。随访期间，2例患者术后半年、4例患者术后1年复发，再次给予内镜成功治疗。其余患者随访期间未见复发。结论 EMBM具有操作简单、用时短和并发症少特点，是治疗食管早癌、尤其是食管癌前病变安全有效的方法。

Abstract:

Abstract: Objective To investigate the efficacy and safety of endoscopic multi-band mucosectomy (EMBM) in treatment of esophageal precancerous lesions and esophageal early cancer. Method A cohort of 75 consecutive patients from January 2013 to June 2016, who underwent EMBM as endoscopic eradication therapy for esophageal precancerous lesions or early esophageal cancer were enrolled. The duration of surgery, complications, change in histopathological stage and follow up records were retrospectively analyzed. Results All of the 75 patients underwent EMBM successfully. The mean duration of surgery was (40.00 ± 9.21) min. Acute bleeding was noted in 3 (4.0%) patients during the operation and they were successfully treated by hot biopsy forceps. No patient had perforations, delayed bleeding or procedure-related deaths. 9 (12.0%) patients developed symptomatic strictures and were successfully treated with balloon dilation. According to histopathlogy from EMBM specimen, of 78 specimen, 24 were low grade intraepithelial neoplasia (LGIN); 45 were high grade intraepithelial neoplasia (HGIN); 9 were intramucosal carcinoma (IMCA). Compared with prior forceps biopsy,histopathology from the EMBM specimen changed in 21 (26.9%). During the follow-up period, 6 patients occurred recurrence (2 patients occurred in half a year after EMBM and 4 patients occurred in 1 year after EMBM). All of the six patients were successfully treated once again with endoscopy. Conclusion EMBM is safe and effective to eradication of esophageal precancerous and early esophageal cancer.