内镜黏膜下剥离术治疗早期下咽癌及癌前病变的可行性研究

Feasibility study of endoscopic submucosal dissection for early hypopharyngeal carcinoma and precancerous lesions

摘要:

摘要：目的??探讨内镜黏膜下剥离术（ESD）治疗早期下咽癌及癌前病变的可行性。方法 回顾性分析2016年2月－2018年12月在浙江省肿瘤医院内镜科行ESD治疗的10例早期下咽癌及癌前病变患者的病例资料，评价ESD治疗的安全性及有效性。结果 10例患者共计12处下咽病变行ESD治疗，病变长径0.8?～3.0?cm，平均（1.7±0.8）cm，均一次性完整切除，整块切除率100%，ESD治疗时间20～160?min，平均（65.6±46.0）min。术后并发迟发性出血1例，呼吸困难1例，经内镜及内科保守治疗后痊愈；无穿孔、皮下气肿等并发症发生。ESD术后病理提示：低级别上皮内瘤变（LGIN） 3处，高级别上皮内瘤变（HGIN）5处，中分化鳞状细胞癌（SCC）4处。除1例SCC基底切缘阳性追加放疗外，其余病变周切缘及基底切缘均阴性。中位随访时间21.5个月（5～39个月），1例患者并发食管入口狭窄，扩张后成功解除梗阻；无局部残留及复发转移。结论 ESD治疗早期下咽癌及癌前病变安全有效，值得临床推广应用。

Abstract:

Abstract: Objective?To explore the feasibility of endoscopic submucosal dissection (ESD) for early hypopharyngeal carcinoma and precancerous lesions.?Methods?Clinical data of 10 patients who received ESD for early hypopharyngeal carcinoma and precancerous lesions from Feb 2016 to Dec 2018 were retrospectively analyzed, and the safety and efficacy were evaluated.?Results?10 patients with a total of 12 hypopharyngeal lesions were treated by ESD. The average length of lesions was (1.7?±?0.8) cm (0.8?~?3.0 cm), and the average operation time was (65.6?±?46.0) min (20?~?160 min). All of the lesions were resected by ESD successfully, with an en bloc resection rate was 100%. The result showed that 1 case occurred delayed bleeding and another case occurred dyspnea after ESD, all of them were successfully recovered by endoscopic and conservative treatment. There were no perforation, subcutaneous emphysema or other complications occurred. Pathology revealed 3 low-grade intraepithelial neoplasia, 5 high-grade intraepithelial neoplasia, and 4 moderately differentiated squamous cell carcinoma. Except for one lesion of squamous cell carcinoma had positive vertical margin and added radiotherapy, all of other lesions had tumor-free horizontal and vertical margins. With the exception of one patient occurred esophageal portal stenosis and successfully relieved after dilatation, no local residual, recurrence or metastasis was detected during the median follow-up period of 21.5 months (5?~?39 months).?Conclusion?ESD is a safe and effective procedure for treatment of early hypopharyngeal carcinoma and precancerous lesions, which is worthy of clinical application.