食道早癌的诊断与治疗进展1.pptVIP

早期食道癌的诊断与治疗进展Progression of diagnosis and treatment on early esophageal carcinoma Definition Definition Involving mocosa or superficial submucosa (m1,2,3;sm1) Minimal risk of lymphatic spread (5%) Hirofumi et al,surg laparosc endos tech,2000 Definition 早期食管癌是指癌组织局限于食管黏膜层以内且无淋巴结转移及远处转移者。 张月明，王贵齐. 早期食管癌的内镜诊 断与治 疗进展. 2008,中国消化内镜 Characteristic Characteristic Significantly better survival-90% Difficultly to eaely diagnosis detection of in situ carcinoma, is made in only 31% of patients. Less than 5% of patients are Case diagnosed at surveillance. How to find EEC Asymptomatic High risk group head and neck cancer heavy smoker ; heavy drinker history of ESCC treated with chemoRT High risk rigion(Northern China) How to recognize the EEC? Regular (white light) endoscopy Lugol chromoendoscopy Endoscopic Ultra-sound，EUS Magnifying Endoscopy；Narrow-band Imaging，NBI Florescence endoscopy; Autoflorescence Imaging,AFI Optical Coherence Tomography, OCT Confocal Endomicroscope Regular endoscopy Regular endoscopy Lugol chromoendoscopy Vital staining Lugol chromoendoscopy Lugol chromoendoscopy Detection of EEC in high risk group other chromoendoscopy 甲苯胺蓝染色 双重染色法 美蓝-卢戈液染色 甲苯胺蓝-卢戈液染色 对于评价病变的浸 润 深度有一定的意义 Endoscopic Ultra-sound AIM Assession of depth observation of lymphoid node Appearance 管壁黏膜层增厚、层次紊乱、中断及各层次分界消失较小的不规则低回声影 Endoscopic Ultra-sound 微探头超声(Miniprobe Sonography, MPS) 对癌浸润深度判断准确率为81.8%, 对区域淋巴结转移的判断敏感性为88.9%, 特异性为77.8% 。 廖嘉忠,韦代林右江民族医学院报,2005,1:106-108 Magnifying Endoscopy；Narrow-band Imaging，NBI) Role of Magnifying Endoscopy 80×magnification Vascular pattern(IPCL) at mucosal level AIM Severe dysplasia Narrow-band Imaging，NBI 依靠光谱组合来显现病变范围及IPCL形态 ,实现了内镜下“光染色”,无需辅助药物,代表了生物学内镜及分子内镜的发展趋势. NBI 结合放大内镜能够初步判断早期病变的组织学诊断, 对病变进行靶向活检具有指导意义和临床实