内镜下黏膜切除术治疗食管早期癌及癌前病变.docVIP

内镜下黏膜切除术治疗食管早期癌及癌前病变【摘要】目的：探讨内镜下黏膜切除术（EMR）治疗早期食管癌、癌前期病变的方法、效果及并发症。方法：2003年8月~2006年3月经色素内镜筛查且活检证实为早期癌及重度不典型增生41例患者，在异丙酚静脉麻醉下进行了EMR治疗，其中早期癌10例，重度不典型增生31例。结果：对早期癌及重度不典型增生的41例病人进行了内镜下EMR。出血、黏膜下血肿等并发症3例，无穿孔及狭窄等严重并发症。结论：EMR是治疗早期食管癌、癌前期病变的安全而有效的方法。 【关键词】早期食管癌；癌前期病变；黏膜切除术；异丙酚 文章编号：1009-5519（2007）17-2557-03 中图分类号：R73 文献标识码：A Endoscopic mucosal resection for precancerous lesions and early esophageal cancer ZHOU Rui-xue，LI Su-hua，TANG Ping，et al. (Department of Gastroenterology，The People’s Hospital of Feicheng，Shandong 271000，China) 【Abstract】Objective：To explore the methods、effectiveness and complications of endoscopic mucosal resection(EMR) in the treatment of precancerous lesions and early esophageal cancer.Methods：From Aug 2003 to Mar 2006,EMR was performed on 41 patients with precancerous lesions and early esophageal cancer who were confirmed by chromoendoscopy with propofol phlebonarcosis，which included 10 cases of early esophageal cancer，31 cases of severe precancerous lesions.Results：EMR was performed on 41 patients with severe precancerous lesions and early esophageal cancer.There were 3 cases of complications which included asymptomatic bleeding，submuscosal haematoma，etc.Neither perforation nor stricture had occurred in these patients. Conclusion：EMRis a promising clinical therapeutic masure showing the advantages of safety and effectiveness in the treatment of precancerous lesions and early esophageal cancer. 【Key words】Early esophageal cancer；Precancerous lesions；Endoscopic mucosal resection；Propofol 2003年以来对我市所属乡镇进行了早期食管癌的色素内镜筛查，对查出的早期食管癌、癌前期病变进行了黏膜切除术（EMR），取得了较好的效果。 1 资料与方法 1.1 病例选择：2003年8月~2006年3月经内镜筛查，并活检证实为早期癌及重度不典型增生41例患者进行了EMR，其中早期癌10例，重度不典型增生31例。病变位于食管上段3例，中段32例，下段5例，中下段各一处病变1例。男27例，女14例。年龄40~70岁，平均57岁。病变表面有溃疡及溃疡瘢痕，病变部位有明显隆起，病变范围超过周径的3/4，黏膜下注射后病变处黏膜不能与黏膜下组织充分分离，视为EMR的禁忌证。 1.2 器械与药物：应用olympus1T140电子胃镜，SD-7P-1圈套器，MAS-295透明帽， ERBE ICC-200高频电刀，APC-300氩离子凝固器，1.2%碘液进行食管黏膜染色，1∶100 000的肾上腺素盐水。 1.3 术前准备：常规胃镜检查准备，签麻醉及内镜下治疗知情同意书。术前