CAJ | 학술논문

目的探讨多环黏膜切除术(MBM)治疗食管高级别上皮内瘤变的疗效和安全性.方法回顾性分析2011年4月至2012年10月河南宏力医院收治的24例食管高级别上皮内瘤变患者的临床资料.24例患者均行MBM,分析患者手术时间、病变切除及并发症情况.术后1、3、6、12个月分别复查胃镜.随访时间截至2013年4月.结果 24例患者共26个病灶均顺利完成MBM治疗(其中2例行2次MBM治疗),平均手术时间为42 min.病灶长径为0.8 ～6.0 cm,平均3.1 cm,最宽占食管周径3/4.分别使用套扎环1～6发,平均4发.术中4例患者出现明显出血,经热火检钳电灼后出血停止,未并发食管穿孔.术后病理检查结果提示重度不典型增生22例,原位癌2例.术后随访6 ～ 24个月,22例患者愈合良好;1例患者(病变范围占食管周径3/4)术后1个月出现食管瘢痕狭窄,行内镜下球囊扩张治疗症状缓解;1例患者(2处病变,分2次完成手术)术后3个月复查胃镜示病变复发,再次活组织检查考虑鳞状细胞癌,遂行外科手术治疗,术后12个月复查胃镜未见狭窄及新生物.结论 MBM是内镜下切除食管高级别上皮内瘤变安全有效的治疗方法.但是切除病变范围不宜过大,对于病变范围超过食管周径3/4,多源病变不能一次性行MBM切除治疗的患者,术后容易出现食管狭窄及病变复发,应慎重选择.
목적 탐토다배점막절제술(MBM)치료식관고급별상피내류변적료효화안전성.방법 회고성분석2011년4월지2012년10월하남굉력의원수치적24례식관고급별상피내류변환자적림상자료.24례환자균행MBM,분석환자수술시간、병변절제급병발증정황.술후1、3、6、12개월분별복사위경.수방시간절지2013년4월.결과 24례환자공26개병조균순리완성MBM치료(기중2례행2차MBM치료),평균수술시간위42 min.병조장경위0.8 ～6.0 cm,평균3.1 cm,최관점식관주경3/4.분별사용투찰배1～6발,평균4발.술중4례환자출현명현출혈,경열화검겸전작후출혈정지,미병발식관천공.술후병리검사결과제시중도불전형증생22례,원위암2례.술후수방6 ～ 24개월,22례환자유합량호;1례환자(병변범위점식관주경3/4)술후1개월출현식관반흔협착,행내경하구낭확장치료증상완해;1례환자(2처병변,분2차완성수술)술후3개월복사위경시병변복발,재차활조직검사고필린상세포암,수행외과수술치료,술후12개월복사위경미견협착급신생물.결론 MBM시내경하절제식관고급별상피내류변안전유효적치료방법.단시절제병변범위불의과대,대우병변범위초과식관주경3/4,다원병변불능일차성행MBM절제치료적환자,술후용역출현식관협착급병변복발,응신중선택.
Objective To investigate the efficacy and safety of multi-band mucosectomy (MBM) for the treatment of high-grade intraepithelial neoplasia.Methods The clinical data of 24 patients with high-grade esophageal intraepithelial neoplasia who were admitted to the Henan Honliv Hospital from April 2011 to October 2012 were retrospectively analyzed.All the 24 patients received MBM,and the operation time,resection of the lesion and complications were observed.All the patients were followed up with gastroscopy at postoperative 1,3,6,12 months.The follow-up was ended in April 2013.Results A total of 26 lesions in 24 patients were resected successfully by MBM (2 patients received MBM twice).The mean operation time was 42 minutes.The mean length of the lesions was 3.1 cm (range,0.8-6.0 cm),and it occupied 3/4 of the circumference of the esophagus to the maximum.The mean number of the band used was 4 (range,1-6).During the operation,bleeding was occurred in 4 patients,and they were cured by hot biopsy forceps.No perforation of the esophagus was detected.The results of post-MBM pathological examination showed that 22 patients were with severe atypical hyperplasia,and 2 were with carcinoma in situ.During the follow-up of 6-24 months,22 patients were cured,and esophageal stricture occurred in 1 patient at post-MBM 1 month,and the symptoms were successfully relieved by endoscopic balloon dilatation.Neoplasia recurrence was observed in 1 patient (2 lesions were resected twice) at post-MBM 3 months,and he received surgical treatment.Histopathological diagnosis showed that he had esophageal squamous cell carcinoma.No stricture or neoplasia was detected by gastroscopy at postoperative month 12.Conclusions MBM is a relatively safe and effective endoscopic technique for the treatment of high-grade esophageal intraepithelial neoplasia.The resection range should not be blindly extended.For patients whose lesions are beyond 3/4 of the circumference of the esophagus in width or with multiple lesions which can not be resected by MBM at one time,MBM should be applied cautiously to avoid esophageal stricture and recurrence.