CAJ | 학술논문

目的评价多环黏膜切除术(MBM)治疗早期食管癌及其癌前病变安全性和疗效.方法对28例行MBM治疗早期食管癌及其癌前病变患者的病例资料进行回顾性分析,总结并发症发生情况以及治疗结果和随访情况.结果 28例共32处病变均经一次操作切除,操作时间18～60 min,平均28.3 min,切除标本直径6～ 20 mm,平均12 mm,全部标本基底无癌残留,术后病理证实黏膜内癌2例、黏膜下癌1例,其余25例均为鳞状上皮中-重度异型增生.无一例食管穿孔,术后未出现迟发性出血及皮下气肿,发生术中出血23例,其中搏动性出血3例,均以钛夹1枚止血成功,其余20例为创面少量渗血,自行止血或以氩气刀止血成功.另有5例术后感胸痛,均自行缓解.1例黏膜下癌追加手术治疗,未见癌残留及淋巴结转移,其余27例内镜随访2～12个月,发生食管狭窄2例,给予探条扩张或食管支架置入后吞咽困难均明显缓解,随访期内无一例病灶局部复发和转移发生.结论 MBM作为一项相对简单的内镜技术,用于早期食管黏膜内癌及癌前病变的治疗是安全的,近期疗效显著,但远期疗效尚需大样本和足够的随访时间来证实.
목적 평개다배점막절제술(MBM)치료조기식관암급기암전병변안전성화료효.방법 대28례행MBM치료조기식관암급기암전병변환자적병례자료진행회고성분석,총결병발증발생정황이급치료결과화수방정황.결과 28례공32처병변균경일차조작절제,조작시간18～60 min,평균28.3 min,절제표본직경6～ 20 mm,평균12 mm,전부표본기저무암잔류,술후병리증실점막내암2례、점막하암1례,기여25례균위린상상피중-중도이형증생.무일례식관천공,술후미출현지발성출혈급피하기종,발생술중출혈23례,기중박동성출혈3례,균이태협1매지혈성공,기여20례위창면소량삼혈,자행지혈혹이아기도지혈성공.령유5례술후감흉통,균자행완해.1례점막하암추가수술치료,미견암잔류급림파결전이,기여27례내경수방2～12개월,발생식관협착2례,급여탐조확장혹식관지가치입후탄인곤난균명현완해,수방기내무일례병조국부복발화전이발생.결론 MBM작위일항상대간단적내경기술,용우조기식관점막내암급암전병변적치료시안전적,근기료효현저,단원기료효상수대양본화족구적수방시간래증실.
Objective To evaluate the safety and efficacy of multi-band mucosectomy (MBM) for early esophageal cancer and precancerous lesions.Methods Data of 28 patients with early esophageal cancer or precancerous lesions undergoing MBM were reviewed in regarding of procedure complications and follow-up results.Results A total of 32 lesions were resected successfully by MBM in one session,with mean procedure time of 28.3 minutes.The mean diameter of specimens was 12mm.No residual neoplasm was found at the base of any resected specimens.The post-MBM pathological findings consisted of 2 cases of intramucosal cancer,1 case of submucosal cancer,and 25 cases of moderate-severe dysplasia.No perforation,delayed hemorrhage or subcutaneous emphysema occurred.Intraoperative bleeding occurred in 23 cases,including 3 cases of pulsatile bleeding,which were controlled with metal clip,and 20 cases of minor bleeding which were managed with APC or halted automatically at the end of procedure.Chest pain after the procedure occurred in 5 cases and were relieved soon.The patient with submucosal cancer underwent subsequent surgical resection,with no residual cancer in surgical specimen or lymph node metastasis.Twenty seven other cases were followed up endoscopically for 2-12 months.Esophageal stricture occurred in 2 cases,and were successfully relieved by dilatation with stent or bougienage.No recurrent lesion or metastasis were revealed.Conclusion MBM is a relatively safe and effective endoscopic technique for treatment of early esophageal intramucosal cancer and precancerous lesions,but further studies are needed to evaluate the long-term results.