摘要
目的胆汁反流性胃炎(Bile Reflux Gastritis,BRG)是消化系统常见病之一,目前仍多采用内镜检查诊目的探讨内镜下粘膜切除术(Endoscopic Mucosal Resection,EMR)联合氩离子凝固术(Argon Plasma Coagulation,APC)在食管癌高发区治疗早期食管癌及其癌前病变的意义。方法应用透明帽法对食管癌高发区普查中发现的31例食管鳞状细胞原位癌、23例食管鳞状上皮重度不典型增生、1例食管鳞状上皮中等不典型增生行EMR,应用APC治疗残留及复发病灶。术后2、6、12个月进行内镜复查。结果(1)在2004～2007年间共55例患者成功行EMR,治疗成功率为100%;(2)并发症:术中出血3例,术后出血2例,经内镜下治疗或保守治疗均成功止血;无一例穿孔、狭窄等并发症发生;(3)随访:本组55例中,19例原位癌和11例重度不典型增生术后半年随访时行内镜下活检,其中有4例重度不典型增生、7例中度不典型增生和6例轻度不典型增生,均内镜下APC治疗。平均随访21个月,无一例复发。结论应用透明帽法内镜下粘膜切除联合氩离子凝固术治疗早期食管癌及其癌前病变是干预食管癌的发生实现二级预防的有效方法。
Objective： To evaluate the effect of endoscopic esophageal mucosal resection （EMR） with transparent cap-fitted endoscope combined with argon plasma coagulation （APC） to treat early esophageal cancer and precancerous lesion of esophageal cancer in the high incidence area. Methods： Endoscopic esophageal mucosal resection were performed with transparent-cap technique on 31 cases of carcinoma in situ, 23 cases of severe hyperplasia and 1 case of middle hyperplasia, the residual lesions were treated by APC. All patients were followed up by endoscopic examination 2 months, 6 months, and 12 months after the therapy. Results： （ 1 ） From 2004 to 2007, 55 cases were treated with EMR and the success rate is 100%. （2） Complication： 3 cases complicated with bleeding during the EMR, 2 cases bleeding after EMR, all the complications were controlled successfully by endoscopic and conservative treatment. None case suffered from perforation and stenosis. （3） Follow-up： 19cases with carcinoma in situ and 11 cases with sever hyperplasia were biopsies at 6 months after EMR, the residual lesions were found in 4 cases with sever hyperplasia, 7 cases with middle hyperplasia and 6 cases with mild hyperplasia. All residual lesions were treated by APC. All cases survived without any discomfort after a follow-up of 21 months on average. Conclusion： EMR with transparent cap-fitted endoscope combined with APC to treat early esophageal cancer and precancerous lesion of esophageal cancer is promising method to prevent the development of advanced esophageal cancer.
出处
《中国消化内镜》
2008年第9期48-52,共5页
Digestive Disease and Endoscopy
关键词
早期食管癌
癌前病变
内镜下粘膜切除术
Early esophageal cancer
Precancerous lesion
Endoscopic mucosal resection
