新型多环黏膜套切除术治疗食管早癌和上皮内瘤变的疗效和安全性分析..docVIP

新型多环黏膜套切术治疗食管早癌和上皮内瘤变 的疗效和安全性分析 李通1 魏艳芹1 王淑云1 赵博超1 张晓梅2 河北省安国市医院 071200 消化内科（李通、魏艳芹），麻醉科（王淑云），病理科（赵博超）；2.中国人民解放军总医院 100853 消化内科（张晓梅） 通讯作者：李通，TELEmail：xxx800809@ 【摘要】 目的 探讨内镜下新型多环黏膜套切术（EMBM）治疗食管早癌和上皮内瘤变的疗效和安全性。方法 回顾性分析2011年6月至2013年12月我院消化内科接受EMBM治疗的34例食管早癌和上皮内瘤变患者的临床资料，总结其治疗效果及安全性。结果 34例患者共36处病灶均一次性顺利完成EMBM术，手术操作时间15-50min，平均24.5min。术后病理证实高级别上皮内瘤变24处、低级别上皮内瘤变4处、黏膜内癌6处、黏膜下浅层癌1处、黏膜下深层癌1处。术中出血2例，予热活检钳钳夹电凝止血，术后无迟发出血及皮下气肿，无1例食管穿孔发生。术后食管狭窄2例，给予沙氏探条扩张后吞咽困难明显缓解。1例黏膜下深层癌基底见淋巴管浸润，转胸外科追加手术治疗。其余33例内镜随访6-24个月，未见1处病灶局部复发和转移发生。结论 EMBM治疗食管早癌和上皮内瘤变操作简单、微创、安全、疗效显著，值得推广。 【关键词】 食管癌；早期；上皮内瘤变；多环黏膜套切术 Endoscopic multi-band mucosectomy in the treatment of early esophageal cancer and intraepithelial neoplasia: An analysis for efficacy and safety Li Tong* Wei Yan-qin Wang Shu-yun Zhao Bo-chao Zhang Xiao-mei (*Department of Gastroenterology ,HebeiAnguo Hospital.071200,China） 【Abstract】Objective: To investigate the safety and efficacy of endoscopic multi-band mucosectomy (EMBM) in the treatment of early esophageal cancer and intraepithelial neoplasia. Methods: A retrospective analysis was made on the clinical data of 34 cases diagnosed with early esophageal cancer and intraepithelial neoplasia. All the patients accept EMBM in our hospital from June 2011 to December 2013. We summarize its therapeutic effect and safety. Results: A total of 34 patients with 36 lesions were successfully completed the treatment in one session. The operation time was 15-50min(average,24.5min). The entire biopsy specimen was tested by pathological examination.High-grade intraepithelial neoplasia in 24 cases, low-grade intraepithelial neoplasia in 4 cases, intramucosal cancer in 6 cases, a submucosal shallow cancer and a submucosal deep cancer were diagnosed. Clamps electric coagulation hemostasis was used during the operation in 2 bleeding cases. No delayed postoperative bleeding, subcutaneous emphysema and esophageal perforation happened. Two cases appeared esophageal stenosis after EMBM. S