CAJ | 학술논문

目的探讨多环黏膜切除术(MBM)治疗早期食管癌及癌前病变的临床价值.方法回顾性分析2010年1月至2011年1月山东济宁医学院附属滕州市中心人民医院收治的43例食管癌以及癌前病变患者的临床资料.43例患者(13例早期癌、30例癌前病变)共51个病灶经术前内镜检查及黏膜活组织检查证实后行MBM治疗.术后1、3、6、12个月门诊行内镜检查并于原病灶处进行活组织检查,以后每6个月定期复查内镜.结果 43例患者共行52次MBM,共切除标本180份；切除病灶大小为10 mm×8mm～25 mm×23 mm；手术时间为(37±5)min.病灶完全切除率为92.2％ (47/51).4例未完全切除病灶的患者中,1例早期食管癌患者术后病理检查示鳞状细胞癌侵犯黏膜下层,切缘见癌细胞浸润而追加手术治疗；1例鳞状上皮癌患者术后2周追加放射治疗；其余2例患者追加氩离子凝固术(APC)治疗.52次MBM术中出现4次创面出血,治疗过程中均未出现食管穿孔.1例患者术后10 d发生延迟性出血,行APC止血；1例发生食管轻度狭窄,无需扩张治疗,6个月后逐渐恢复.手术前后病理检查结果准确率为51.0％(26/51).43例患者随访1年,3例复发,复发患者行MBM或APC治疗,无一例患者死亡.结论 MBM治疗早期食管癌及癌前病变简便、安全、有效,有较好的应用前景.
목적 탐토다배점막절제술(MBM)치료조기식관암급암전병변적림상개치.방법 회고성분석2010년1월지2011년1월산동제저의학원부속등주시중심인민의원수치적43례식관암이급암전병변환자적림상자료.43례환자(13례조기암、30례암전병변)공51개병조경술전내경검사급점막활조직검사증실후행MBM치료.술후1、3、6、12개월문진행내경검사병우원병조처진행활조직검사,이후매6개월정기복사내경.결과 43례환자공행52차MBM,공절제표본180빈；절제병조대소위10 mm×8mm～25 mm×23 mm；수술시간위(37±5)min.병조완전절제솔위92.2％ (47/51).4례미완전절제병조적환자중,1례조기식관암환자술후병리검사시린상세포암침범점막하층,절연견암세포침윤이추가수술치료；1례린상상피암환자술후2주추가방사치료；기여2례환자추가아리자응고술(APC)치료.52차MBM술중출현4차창면출혈,치료과정중균미출현식관천공.1례환자술후10 d발생연지성출혈,행APC지혈；1례발생식관경도협착,무수확장치료,6개월후축점회복.수술전후병리검사결과준학솔위51.0％(26/51).43례환자수방1년,3례복발,복발환자행MBM혹APC치료,무일례환자사망.결론 MBM치료조기식관암급암전병변간편、안전、유효,유교호적응용전경.
Objective To investigate the clinical value of multiband mucosectomy (MBM) for the treatment of early esophageal cancer and precancerous lesions.Methods The clinical data of 43 patients with early esophageal cancer or precancerous lesions (including 13 cases of early esophageal cancer and 30 cases of precancerous lesion) who were admitted to the Tengzhou Central People's Hospital from January 2010 to January 2011 were retrospectively analyzed.A total of 51 lesions were confirmed by preoperative endoscopy and mucosal biopsy,and then were treated by MBM.Results A total of 52 MBM procedures were carried out,and 180 lesions were resected.The sizes of the lesions ranged from 10 mm × 8 mm to 25 mm × 23 mm,and the mean operation time was (37 ± 5)minutes.The complete resection rate was 92.2％ (47/51).The submucosal layer of 1 patient was invaded by squamous cell carcinoma postoperatively,and the patient was treated by operation;1 patient wth squamous epithelium carcinoma was treated by radiotherapy at 2 weeks after MBM ; the other 2 lesions were treated by argon plasma coagulation (APC).Four lesions with bleeding were detected during 52 MBM procedures,and no esophageal perforation was detected during MBM.Early complications consisted of delayed bleeding (1 patient,cured by APC) and slight esophageal stenosis (1 patient,recovered at postoperative month 6).The accurate rate of pathological examinations was 51.0％ (26/51).Forty-three patients were followed up for 1 year,3 patients with tumor recurrence were treated by MBM or APC.No death occurred during the followup.Conclusion MBM is a safe and effective technique for the treatment of early esophageal cancer and precancerous lesions.