内镜黏膜下剥离术治疗食管早期癌及癌前病变的疗效

目的：评价临床应用内镜黏膜下剥离术(ESD)治疗食管早期癌及癌前病变是否安全及其预后效果。方法：2008年8月到2011年8月期间共89例患者在安庆市第一人民医院消化内科就诊，均通过ESD治疗食管早期癌及癌前病变，收集患者的实验室检查和相关病史资料，分析本组患者ESD的治疗效果、术后并发症和远期疗效。结果：随访89例，随访成功率100%。89例患者包括食管早期癌16例，食管高级别内瘤变38例，食管低级别内瘤变35例。ESD一次性整块切除率93.3%(84/89)，一次性完整切除率和治愈性切除率均为92.1%(82/89)；术中穿孔2例，予以术中内镜下修补术；术后迟发性出血1例，均予保守治愈；3例发生食管狭窄。共对89例患者情况进行随访；ESD术后3年内病变再发1例，总复发率1.1%；随访时间10~58(36.3±21.2)个月，3年内死亡2例，3年生存率97.8%。结论：食管早期癌及癌前病变的治疗可以选择ESD，该方法安全性较高并且术后预后良好。

Synthetic evaluation of precancerous lesions and early esophageal cancers after endoscopic submucosal dissection

Objective: To evaluate the safety and prognosis for patients with early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD). Methods: A total of 89 patients were admitted to the Department of internal medicine in the First People's Hospital of Anqing from August 2008 to August 2011. All patients were treated with ESD at the early stage of esophageal cancer and precancerous lesions. The patients’ laboratory data and relevant medical history were collected. The postoperative complications and long-term effects of ESD were analyzed. Results: Eighty-nine patients were followed up with 100% response rate. Among 89 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The one-time whole piece resection rate, complete resection rate and curative resection rate was 93.3% (84/89), 92.1% (82/89) and 92.1% (82/89), respectively. Two cases suffered intraoperative perforation with a rate of 2.2% and these 2 patients performed the intraoperative endoscopic repair; one case suffered the postoperative delayed bleeding with a rate of 1.1% and the patient underwent the conservative treatment; three cases suffered the esophageal stenosis with a rate of 3.4%. All patients were followed-up for 10–58 (36.3±21.2) months. In this period, one case recurred after ESD for 3 years with a rate of 1.1%; two cases were dead. The three-year survival rate was 97.8%. Conclusion: The early esophageal cancer and precancerous lesions can be treated with ESD. The method is safe and the prognosis is good.