CAJ | 학술논문

目的评价内镜套帽法切除早期食管癌、贲门癌及癌前病变的长期疗效和应用价值.方法采用内镜套帽法切除早期食管癌、贲门癌及癌前病变147例(154个病灶),其中早期食管癌64例(69个病灶),癌前病变45例(47个病灶),病灶直径3～40 nm,平均(14.8±6.1)mm;早期贲门癌23例,癌前病变15例(均为单灶),病灶直径5～25 mm,平均(8.2±4.3)mm.全组病例均经病理证实.结果全组有139个病灶被完全切除,完全切除率为90.3%.食管和贲门病灶的完全切除率均与病灶大小有关,病灶越大,完全切除率越低(P=0.001和P=0.014).147例患者中,内镜随访不足3年者66例,3～5年者31例,5～10年者43例,10年以上者7例.全组死亡11例,其中肿瘤复发死亡1例.早期食管癌和贲门痈的5年生存率分别为96.2%和100.0%.本组有5例(3.4%)患者发生术中出血,1例(0.7%)患者发生狭窄,无穿孔发生.结论内镜黏膜切除治疗早期食管癌和贲门癌,符合其生物学特点,可达到传统手术治疗相同的长期疗效,亦适用于重度不典型增生的治疗.
목적 평개내경투모법절제조기식관암、분문암급암전병변적장기료효화응용개치.방법 채용내경투모법절제조기식관암、분문암급암전병변147례(154개병조),기중조기식관암64례(69개병조),암전병변45례(47개병조),병조직경3～40 nm,평균(14.8±6.1)mm;조기분문암23례,암전병변15례(균위단조),병조직경5～25 mm,평균(8.2±4.3)mm.전조병례균경병리증실.결과 전조유139개병조피완전절제,완전절제솔위90.3%.식관화분문병조적완전절제솔균여병조대소유관,병조월대,완전절제솔월저(P=0.001화P=0.014).147례환자중,내경수방불족3년자66례,3～5년자31례,5～10년자43례,10년이상자7례.전조사망11례,기중종류복발사망1례.조기식관암화분문옹적5년생존솔분별위96.2%화100.0%.본조유5례(3.4%)환자발생술중출혈,1례(0.7%)환자발생협착,무천공발생.결론 내경점막절제치료조기식관암화분문암,부합기생물학특점,가체도전통수술치료상동적장기료효,역괄용우중도불전형증생적치료.
Objective To evaluate the long.term effect and clinical value of endoscopic mucosal resection(EMR)with transparent cap for dysplasia and early-stage cancer of the esophagus and gastric cardia.Methods From September 1996 to June 2007.154 lesions in the esophagus or gastric cardia of 147 patients were treated using EMR with transparent cap.Among thse lesions,there were 69 early-stage squamous-cell carcinomas in 64 patients and 47 squamous cell precancerous lesions of the esophagus in 45 patients,with an average lesion size of(14.8±6.1)am(range,3～40 mm),furthermore,there were 23 early-stage adenocarcinomas in 23 patients and 15 precancerous lesions in the gastric cardia in 15 patients.with an average lesion size of(8.2±4.3)mm(rang,5～25 mm).All lesions were finally confirmed histopathologically.Results of the 154 lesions,139(90.3%)were resected completely through EMR procedure.A close relationship between the complete resection rate and the lesion size was observed.The bigger the lesion size,the lower the complete resection rate.Endoscopic follow.up was carriecl out in 7 patients for more than 10 years,in 43 for 5-10 years,in 3l for 3-5 years and in 66 for less than 3 years.Of 11 dead patients during following-up,10 died of other diseases,only 1 of recurrence.The 5-year survival rate was 96.2%for early-stage esophageal cancer.and 100%for early cancer of the gastric cardia.Perioperative complications included oozing bleeding in 5 patients(3.4%)and stricture in 1(0.7%),no perforation occurred in this series.Conclusion Endoscopic mucosal resection is suitable to treat precancerous lesions or early-stage esophageal cancers without invasion into submucosa.Compared with conventional resection throuIgh open thoracotomy.similar long-term sunrival and curative effect can be achieved by this EMR treatment,preserving a good quality of life.