内镜下黏膜切除术在治疗早期食管癌和重度不典型增生中的应用

目的探讨内镜下黏膜切除术（EMR）治疗早期食管癌、重度不典型增生的应用价值。方法对我院2004年2月～2009年4月经色素内镜筛查且活检证实为早期食管癌及重度不典型增生的32例患者,在静脉麻醉下进行内镜下黏膜切除术透明帽法治疗,其中早期癌8例,重度不典型增生24例。结果对早期食管癌及重度不典型增生的32例患者进行内镜下黏膜切除术透明帽法治疗,成功27例,小量出血2例,无穿孔及狭窄等严重并发症。结论严格筛选患者行内镜下黏膜切除术透明帽法治疗早期食管癌、癌前病变是安全而有效的方法。     

改良式透明帽在18例上消化道黏膜平坦隆起性病变中临床应用

目的评价改良式透明帽在内镜黏膜切除术中的应用效果,并对其适应症和操作方法等问题进行讨论。方法选择符合内镜黏膜切除术适应症的18例应用改良透明帽,切除了27处病变。对手术发生的并发症进行观察和处理。结果 18例患者中共切除病变27处,完全切除率100%。术后病理诊断起源于黏膜肌层的食管平滑肌瘤2处,食管乳头状瘤3处,黏膜慢性炎2处。胃:增生性息肉12处,炎性息肉7处,重度不典型增生1处。并发症主要是岀血,术中创面渗血2处,均行高频电凝止血。1例发生术后迟发性出血,应用钛夹止血成功。无便血及穿孔发生。结论改良式透明帽在EMR术中可以安全应用,操作简单,特别适合在基层推广应用。     

内镜下结肠黏膜切除术治疗结肠腺瘤54例临床分析

目的为临床开展内镜下粘膜切除治疗结肠膜瘤提供指导。方法对54例结肠腺瘤患者行内镜下结肠黏膜切除术（EMR）。结果54例患者共切除67个病灶,每块病灶粘膜下平均注射。肾上腺素盐水20ml,切除标本面积为（22．5±1．0）mm×（16．5±1．0）mm.40例切除黏膜直径小于3cm者术后2周溃疡表面即完全由再生的腺上皮覆盖,4周完全愈合;14例大于3cm者6～8周愈合。术后6例出血,应用内镜压迫、肾上腺素盐水注射及氢离子凝固术（APC）均成功止血;4例发生狭窄（其中3例切除直径超出结肠全周1／2）,应用水囊扩张,术后1个月狭窄均缓解;未发生穿孔等严重并发症。结论EMR操作简便、安全,治疗结肠腺效果确切;严格掌握手术适应证可明显减少并发症的发生。     

内镜下黏膜切除术治疗食管黏膜隆起肿瘤30例临床分析

目的探讨内镜下黏膜切除术治疗食黏膜管隆起肿瘤的治疗效果及安全性。方法30例胃镜检查发现食管黏膜隆起肿瘤,其中食管黏膜下隆起病变的患者接受超声内镜检查确诊病变源于黏膜肌层,确定无手术禁忌后,进行EMR切除病变,术后病变标本送病理检查。结果30例患者顺利完成EMR切除病变,耗时20—45min,平均为（25±4．7）min。2例患者发生急性出血,予药物喷洒、电凝等治疗后出血停止。所有治疗病例均无急性或延迟性食管穿孔及食管狭窄等并发症出现。结论EMR可有效、安全地切除食管黏膜隆起肿瘤,有较好的临床应用价值。     

镜端透明帽吸引法粘膜切除术的应用

目的：探讨透明帽吸引法的适应证、操作技巧、诊治消化道扁平隆起病变的效果及安全性。方法：粘膜下层注射肾上腺素盐水，使病灶明显隆起，镜端连接透明塑料帽，将病变组织吸入透明帽内，圈套器套取病变组织后高频电凝切除。切下组织全部收集送病理检查，术后定期随访。结果：共切除33个病灶，除1例食管平滑肌瘤和1例残胃Ⅱa c型早期癌未完全切除外，另31例均切除完全。全部病例未发生大出血或穿孔等严重并发症。内镜随访1－12月，除前述的1例残胃早期癌复发外，其余病例均未见复发。结论：透明帽吸引法粘膜切除术对消化道扁平隆起病变是一种简便易行、适应证广、安全有效的切除方法，值得推广应用。     

超声内镜辅助内镜黏膜切除术治疗食管黏膜肌层病变的临床分析

目的回顾分析内镜下黏膜切除术(endoscopic mucosal resection,EMR)对食管黏膜肌层病变的治疗效果,并讨论其并发症和随访结果。方法 40例经超声内镜小探头证实的食管黏膜肌层病变,以注射法行黏膜切除治疗,记录病变大小、超声所见、操作方法、并发症、术后病理类型及随访情况。结果 40处病变经EMR完整切除,一次性完整切除率95.0%(38/40)。并发症:术中创面少许渗血7例(17.5%),均以氩气刀止血成功,无搏动性出血及穿孔发生。无迟发性出血及穿孔发生。术后病理:平滑肌瘤32例,间质瘤3例,炎性肉芽肿3例,血管瘤2例。随访1～12个月,未见病变残留或复发。结论超声内镜联合内镜黏膜切除术,术后常规行免疫组化检查,可完整切除食管黏膜肌层病变,方法安全有效。     

表浅食管癌内镜黏膜下剥离术后局部单次注射曲安奈德预防狭窄疗效观察

背景内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)可一次性完整切除整块病变,目前已被广泛用于表浅食管癌的治疗,但当切除黏膜范围超过3/4 wk时,极易并发顽固性食管狭窄,严重影响患者的生活质量.目的评价创面局部单次注射曲安奈德预防大范围表浅食管癌ESD后狭窄的有效性及安全性.方法回顾性分析2013-01/2017-12在浙江省肿瘤医院内镜中心行ESD治疗的49例大范围表浅食管癌患者的病例资料,前期27例仅行ESD治疗,设为对照组,后期22例ESD术后创面局部注射曲安奈德预防狭窄,设为治疗组.两组均系统内镜随访,并发食管狭窄时予以内镜下球囊扩张(endoscopic balloon dilation, EBD)治疗,直至成功解除梗阻.统计比较两组食管狭窄的发生率及所需的EBD次数.结果治疗组食管狭窄发生率为22.7%(5/22),明显低于对照组74.1%(20/27)(P=0.001);狭窄发生后所需EBD次数,治疗组平均为4.4±2.1次(范围2-7次),亦明显少于对照组,平均8.7±4.2次(范围1-17次)(P=0.037).无局部注射相关的出血、穿孔、纵膈脓肿等严重并发症发生.结论大范围食管ESD术后创面单次注射曲安奈德可以有效预防食管狭窄的发生,并可显著减少EBD治疗次数.     

内镜下黏膜切除术后食管狭窄的危险因素分析

目的 分析食管病变内镜下黏膜切除术后食管狭窄的可能的危险因素.方法 2008年至2009年间,共对219例食管早期癌或癌前病变进行内镜下黏膜切除术治疗,其中9例出现食管狭窄,对这9例患者（狭窄组）的病变性质、范围、治疗情况等进行回顾性分析,并与其它术后无狭窄患者（对照组,n=202,有8例术后病理证实有黏膜下层浸润,转外科手术,未纳入比较）进行比较.结果 两组患者在性别、年龄、病变位置、病变长度及术后病理方面无显著差别,但狭窄组创面范围＞3/4食管周径的比例（8/9,88.9%）明显高于对照组（9/202,4.5%,P＜0.01）.结论 对内镜治疗后范围超过食管周径3/4的早期食管癌或癌前病变,内镜下黏膜切除术后发生食管狭窄的风险明显增加.     

内镜黏膜下剥离术治疗早期食管癌患者的疗效及术后并发症分析

[目的]分析探讨内镜黏膜下剥离术(ESD)治疗早期食管癌患者的疗效及术后并发症。[方法]选取我院2015-05—2016-10行ESD治疗的早期食管癌患者58例,分析病变切除情况、术后并发症发生情况,单因素分析术后食管狭窄发生的危险性因素。[结果]58例患者全部一次性整块切除,手术时间30~90min,术后食管狭窄发生率为44.83%(26/58)。单因素分析显示,手术时间≥50min、病变环周比≥3/4及创伤面积≥8cm^2是术后发生食管狭窄的危险性因素(P<0.05),而术后发热症状与食管狭窄的发生无关。[结论]早期食管癌患者行ESD治疗安全有效,有整块切除率高、术中出血量少、穿孔率低等优势,但术后易出现食管狭窄并发症,需操作者在实践过程中积极把控。     

内镜下黏膜切除术治疗消化道肿瘤

目的 探讨内镜下黏膜切除术(EMR)对消化道肿瘤的治疗价值。方法 利用染色、放大内镜及超声内镜探测病变范围及侵犯深度,对位于黏膜层及黏膜肌层的早期癌、癌前病变、黏膜下肿瘤、侧向发育型息肉、无蒂或亚蒂巨大息肉、息肉癌变等病变行EMR治疗。结果 病灶最大直径6cm。2例早期食管癌、1例早期贲门癌、1例早期大肠癌及2例胃中、重度异型增生经EMR及透明帽负压吸引EMR切除,观察3-18个月无复发;31例黏膜下肿瘤经EMR和透明帽负压吸引EMR,均完全切除;对13例侧向发育型息肉及21例亚蒂和无蒂大息肉及局部癌变息肉采用EMR或分片黏膜切除术切除。术中出血5例,出血率7.04％,经内镜治疗停止。1例4.5 cm腺瘤术后3个月复发。结论 在超声内镜、色素内镜及放大内镜的指导下,采用内镜下黏膜切除术治疗部分消化道早期癌、癌前病变、侧向发育型及无蒂或亚蒂臣大息肉、局部癌变息肉及黏膜肌层的肿瘤,足一项安全有效的内镜治疗疗法。     

Association of esophageal cancer and esophageal varices

Of the 312 cases of esophageal cancer seen over 2 years, four patients had associated varices. Three patients gave history of alcohol abuse. All had malnutrition and splenomegaly. Endoscopic biopsies were safe in the presence of varices. External radiation did not have any untoward effect on the varices. Prophylactic sclerotherapy was not required in these patients. The association between esophageal carcinoma and varices could be secondary to alcohol consumption or merely coincidental.     

Relationship between esophageal achalasia subtypes and esophageal clearance

Esophagus - The diagnosis and pathological evaluation of esophageal achalasia have been improved dramatically by the development of high-resolution manometry. It is currently known to be divided...     

Lower esophageal sphincter pressure, esophageal body motor functioning, and esophageal acid sensitivity

Esophageal acid sensitivity is believed to develop as a result of esophageal acid exposure, contributing factors being gastroesophageal reflux and delayed esophageal acid clearance. The relationship among lower esophageal sphincter pressure, motor functioning of the body of the esophagus, and esophageal acid sensitivity was examined by comparing the results from 912 patients and normal subjects studied with both esophageal manometric and Bernstein acid infusion tests. Positive acid infusions were statistically more closely associated with hypotensive lower esophageal sphincter pressures than with any motor abnormality in the body of the esophagus. Of the several esophageal body motor abnormalities considered, only feeble peristalsis had significantly more positive Bernstein tests than did normal esophageal body motor functioning. The findings from this study demonstrate that hypotensive lower esophageal sphincter pressure is more closely associated with an acid-sensitive esophagus than is impaired esophageal body motor functioning.     

Influence of smoking and esophageal intubation on esophageal pH-metry

The effect of cigarette smoking on gastroesophageal reflux and the effect of the pH electrode on salivary secretion and swallowing frequency were studied in 30 healthy volunteers (15 habitual smokers, 15 non-smokers) and in 10 smoking patients with proven gastroesophageal reflux disease. Twenty-four-hour pH profiles were measured while the subjects were ambulatory using a combined glass electrode connected to a portable recorder. In 8 of the smoking volunteers, swallowing frequency and salivary secretion were measured, both when smoking and when not. Smokers had more reflux episodes than nonsmokers [median per hour 2.8 (range 0.4-7.1) for the upright body position and 0.5 (range 0.0-1.7) for the supine body position vs. 1.4 (range 0.0-2.1) upright and 0.0 (range 0.0-0.7) supine, p less than 0.01], but the total time of exposure of the esophageal mucosa to acid was affected neither by the status of being a smoker nor by actual smoking. Nasopharyngeal intubation with the pH electrode did not affect the swallowing frequency, but it increased salivary secretion two-to threefold for a period of 4 h. Six hours after introduction of the pH electrode and later, salivary flow was similar to baseline. It is concluded that smoking and nasopharyngeal intubation does not adversely affect the results of 24-h pH-metry.     

Endoscopic mucosal resection for early esophageal cancer and esophageal dysplasia

BACKGROUND/AIMS: Advances in diagnostic technology have led to increased detection of early esophageal cancer, which is suitable for endoscopic treatment. We performed endoscopic esophageal mucosal resection of such cancer and dysplasia using the endoscopic esophageal mucosal resection tube and evaluated the clinical benefit of this technique. METHODOLOGY: Twenty-nine patients with esophageal mucosal cancer (27 cases with 33 lesions) or dysplasia (2 cases with 2 lesions) diagnosed between September 1992 and March 1998 were assessed endoscopically for the depth and extent of invasion by double staining with toluidine blue and iodine. Endoscopic ultrasonography was also performed to assess the depth of invasion in 22 cases with 22 lesions. RESULTS: The 35 esophageal lesions comprised 27 esophageal carcinomas and 8 areas of dysplasia. Twenty of the 35 lesions were resected en bloc and 15 were resected piecemeal. Subsequent surgery was performed for 5 cases with 7 lesions out of 10 cases with 15 lesions that were histopathologically diagnosed as m3 or more invasive. No recurrence has been detected in 24 evaluable cases (including 1 who died of another disease, 2 in whom surgery could not be performed due to complications, and 3 who refused subsequent surgery). No patients died of esophageal cancer after a mean follow-up period of 30.9 +/- 18.9 months. The 4-year survival rate was 100% in the m2 or less invasive group of 19 cases with 20 lesions, 75% in the m3 or higher invasive group of 5 cases with 8 lesions and 100% in the surgery group of 5 cases with 7 lesions (NS). No serious complications occurred except for 1 patient. Circumferential mucosal resection was done in this patient, resulting in esophageal stenosis, which responded to esophageal dilation. CONCLUSIONS: Esophageal mucosal resection using the endoscopic esophageal mucosal resection tube is safe and beneficial for early esophageal cancer and dysplasia.     

食管静脉及食管、胃粘膜变化预测门脉高压食管静脉曲张出血的价值

为探讨门脉高压症患者内镜下食管静脉(EV)、食管粘膜及胃粘膜变化预测出血的价值,将60例肝硬化门脉高压患者分为出血组(36例)和非出血组(24例),分别观察其EV曲张形态、范围及颜色,炎性表现,胃粘膜改变及有无胃食管返流病(GERD)等.结果出血组EV曲张范围多超过食管中段,呈灰蓝、樱红色,静脉扭曲呈结节状,外径平均6.0±1.6mm;非出血组EV多局限于食管下段,呈灰白或灰蓝色,外径平均4.2±1.2mm;出血组食管炎20例(55.5%),非出血组5例(20.8%).出血组有胃粘膜损害者20例,非出血组为6例(P＜0.01).认为食管静脉曲张超过中段、外径≥6.0mm、有樱红样征;伴有食管炎、GERD及门脉高压性胃病者的出血率明显增加;上述指标预测门脉高压出血具有实用价值.     

Correlation of lower esophageal mucosal ring and lower esophageal sphincter pressure

We assessed the relationship of lower esophageal sphincter pressure (LESP) to presence and absence of lower esophageal mucosal ring (LEMR) in 66 patients to determine if the LEMR was more likely related to prolonged sphincter hypotension. This potential relationship is of interest because LEMR may be due to reflux esophagitis. Each patient had radiographic and manometric studies, and both examinations were done within one week of each other. The mean LESP in patients with LEMR was 23.8 mm Hg (range 4.2–64 mm Hg) compared to 28.7 mm Hg (range 8–59 mm Hg) in patients without LEMR; the difference was not statistically significant. Patients with LEMR were also divided into three subgroups according to the diameter of the rings (13 mm, 14–19 mm, 20 mm). There was no significant relationship between the caliber of LEMR and LESP (P>0.05). Presence of LEMR did not affect the amplitude or duration of primary esophageal peristalsis. These results do not support a relationship between LEMR and prolonged LESP hypotension or abnormal esophageal motility. However, other pathogenetic mechanisms involved in producing reflux esophagitis not related to prolonged sphincter hypotension were not studied.