内镜黏膜下剥离术治疗早期食管癌的安全性和有效性分析
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摘要
目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期食管癌的安全性及有效性。方法收集2013年10月～2018年10月阳江市人民医院接受ESD治疗的51例早期食管癌的临床病理资料,统计分析术后病理、R0切除率、并发症及随访情况。结果 1、术后病理提示为鳞癌50例(98. 0%),腺癌1例(2. 0%);水平/垂直切缘阳性率7. 8%(4例),R0切除率92. 2%(47例)。2、ESD术后出血2例(3. 9%),食管狭窄4例(7. 8%),无一例穿孔。3、中位随访时间22个月,49例患者进行了至少一次的内镜下复查,创面愈合率100%,术后复发率6. 1%(3例)。结论 ESD在治疗早期食管癌患者中具有R0切除率高、并发症少、复发率低等优点,具有良好的安全性和有效性,值得推广。
引文
[1]李鹏,王拥军,陈光勇,等.中国早期食管鳞状细胞癌及癌前病变筛查与诊治共识(2015年·北京)[J].中国实用内科杂志,2016,1:20-33.
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[3] Lian J,Chen S,Zhang Y,et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer[J].Gastrointest Endosc,2012,76(4):763-770.
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[6] Zhou PH,Shi Q,Zhong YS,et al. New progress in endoscopic treatment of esophageal diseases[J]. World J Gastroenterol,2013,19(41):6962-6968.
[7] Omae M,Fujisaki J,Horiuchi Y,et al. Safety,efficacy,and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer[J]. Gastric Cancer,2013,16(2):147-154.
[8] Probst A,Aust D,Mrkl B,et al. Early esophageal cancer in Europe:endoscopic treatment by endoscopic submucosal dissection[J]. Endoscopy,2015,47(2):113-121.
[9]李岩,徐宏伟,陆喜荣,等.内镜黏膜下剥离术治疗早期食管癌及癌前病变[J].胃肠病学和肝病学杂志,2012,21(11):1051-1053.
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[11] Kobayashi S,Kanai N,Dhki T,et al. Prevention of esophageal strictures after endoscopic submucosal dissection[J]. World J Gastroenterol,2014,20(41):15098-15109.
[12]董会娟,周婷婷,张俊丽,等.内镜黏膜下剥离术治疗食管早期癌患者术后并发再狭窄的危险因素分析[J].四川医学,2017,38(10):1208-1211.
[13] Noguchi M,Yano T,Kato T,et al. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma[J]. World J Gastroenterol,2017,23(3):478.
[14] Goto O,Yahagi N. Endoscopic Treatment:EMR and ESD[M]//Esophageal Squamous Cell Carcinoma. Springer Japan,2015:251-260.
[15]滕晓丽,陈洁.内镜黏膜剥离术在早期食管癌及癌前病变中的疗效观察[J].临床消化病杂志,2016,28(4):240-244.
[16]徐芳媛,尹成龙,袁志萍,等.内镜黏膜下剥离术治疗早期食管癌及癌前病变的临床评价[J].中华消化病与影像杂志:电子版,2013,3(5):9-14.
[17] Barret M,Cao DT,Beuvon F,et al. Endoscopic submucosal dissection for early Barrett’s neoplasia[J]. United European Gastroenterol J,2016,4(2):207-215.
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[19] Kiriyama S, Saito Y, Yamamoto S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer:a retrospective analysis[J]. Endoscopy,2012,44(11):1024.
[20]程如焕,郭慧敏,汪忠红,等. ESD治疗食管早癌及上皮内瘤变的价值[J].现代消化及介入诊疗,2018,23(5):7-9,13.
[21] Isomoto H,Yamaguchi N,Nakayama T,et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma[J].BMC Gastroenterol,2011,11(1):46.
[2]李开学,郭海建,刘俊,等.内镜黏膜下剥离术与外科手术治疗食管早癌及癌前期病变的疗效比较[J].海南医学,2017,28(13):2104-2106.
[3] Lian J,Chen S,Zhang Y,et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer[J].Gastrointest Endosc,2012,76(4):763-770.
[4] Zhong DD,Shao LM,Cai JT. Endoscopic mucosal resection vs endoscopic submucosal dissection for rectal carcinoid tumours:a systematic review and meta-analysis[J]. Colorectal Dis,2013,15(3):283-291.
[5] Tanimoto MA,Torresvillalobos G,Fujita R,et al. Endoscopic submucosal dissection in dogs in a World Gastroenterology Organisation training center[J]. World J Gastroenterol,2010,16(14):1759-1764.
[6] Zhou PH,Shi Q,Zhong YS,et al. New progress in endoscopic treatment of esophageal diseases[J]. World J Gastroenterol,2013,19(41):6962-6968.
[7] Omae M,Fujisaki J,Horiuchi Y,et al. Safety,efficacy,and long-term outcomes for endoscopic submucosal dissection of early esophagogastric junction cancer[J]. Gastric Cancer,2013,16(2):147-154.
[8] Probst A,Aust D,Mrkl B,et al. Early esophageal cancer in Europe:endoscopic treatment by endoscopic submucosal dissection[J]. Endoscopy,2015,47(2):113-121.
[9]李岩,徐宏伟,陆喜荣,等.内镜黏膜下剥离术治疗早期食管癌及癌前病变[J].胃肠病学和肝病学杂志,2012,21(11):1051-1053.
[10]陈昌英. MMP-3,MMP-9和TIMP-3在食管鳞癌中的表达及临床意义[D].东南大学,2015.
[11] Kobayashi S,Kanai N,Dhki T,et al. Prevention of esophageal strictures after endoscopic submucosal dissection[J]. World J Gastroenterol,2014,20(41):15098-15109.
[12]董会娟,周婷婷,张俊丽,等.内镜黏膜下剥离术治疗食管早期癌患者术后并发再狭窄的危险因素分析[J].四川医学,2017,38(10):1208-1211.
[13] Noguchi M,Yano T,Kato T,et al. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma[J]. World J Gastroenterol,2017,23(3):478.
[14] Goto O,Yahagi N. Endoscopic Treatment:EMR and ESD[M]//Esophageal Squamous Cell Carcinoma. Springer Japan,2015:251-260.
[15]滕晓丽,陈洁.内镜黏膜剥离术在早期食管癌及癌前病变中的疗效观察[J].临床消化病杂志,2016,28(4):240-244.
[16]徐芳媛,尹成龙,袁志萍,等.内镜黏膜下剥离术治疗早期食管癌及癌前病变的临床评价[J].中华消化病与影像杂志:电子版,2013,3(5):9-14.
[17] Barret M,Cao DT,Beuvon F,et al. Endoscopic submucosal dissection for early Barrett’s neoplasia[J]. United European Gastroenterol J,2016,4(2):207-215.
[18] H9lscher A H,Bollschweiler E,Schr9der W,et al. Prognostic impact of upper,middle,and lower third mucosal or submucosal infiltration in early esophageal cancer[J]. Ann Surg,2011,254(5):802-807.
[19] Kiriyama S, Saito Y, Yamamoto S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer:a retrospective analysis[J]. Endoscopy,2012,44(11):1024.
[20]程如焕,郭慧敏,汪忠红,等. ESD治疗食管早癌及上皮内瘤变的价值[J].现代消化及介入诊疗,2018,23(5):7-9,13.
[21] Isomoto H,Yamaguchi N,Nakayama T,et al. Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma[J].BMC Gastroenterol,2011,11(1):46.