内镜黏膜下剥离术治疗黏膜肌层或下层食管癌的短期疗效分析

doi:10.3877/cma.j.issn.2095-8773.2017.04.04

目的

探讨内镜黏膜下剥离术(ESD)治疗黏膜肌层或黏膜下层侵犯食管鳞癌的指证选择和早期结果。

方法

收集上海市胸科医院食管外科2014年6月—2017年6月行ESD治疗的食管鳞癌患者资料，选取其中病理侵犯深度至黏膜肌层或黏膜下层(T1a-M3～T1b)的22例患者，病变位于食管中段16例，食管下段6例。分析患者的一般资料、术后并发症、综合治疗以及短期随访结果。

结果

22例食管鳞癌患者中，行R0切除10例(45.5%)；R1切除12例，其中基底切缘阳性3例，侧切缘阳性9例；标本病理分型T1a-M₃ 9例(40.9%)，T1b 13例(59.1%)。术后中位随访时间6.0个月，随访过程中并发食管狭窄行内镜下扩张术3例(13.6%)。术后再治疗患者7例，4例接受挽救性手术(其中1例为术后6个月复发后再次手术)，3例接受放化疗。手术切除情况与肿瘤浸润深度相关(P＝0.0274)，与病变长度无相关性(P＝0.2659)。

结论

ESD切除结合放化疗可作为黏膜肌层或黏膜下层侵犯早期食管癌的治疗选择，手术切除情况与肿瘤浸润深度密切相关，与病变长度无相关性。

关键词: 早期食管癌, 黏膜肌层, 黏膜下层, 内镜黏膜下剥离术, 短期疗效

Objective

To discuss the choices and early results of endoscopic submucosal dissection(ESD) treatment of muscularis mucosal or submucosal invasion of esophageal squamous cell carcinoma.

Methods

The clinical data of patients with esophageal squamous cell carcinoma undergoing ESD surgery in Shanghai Chest Hospital between June 2014 and June 2017 were reviewed. The pathological invasion of 22 cases is the muscularis mucosa or submucosa (T1a-M3-T1b). In 16 cases the lesions were located in the middle esophagus and 6 cases in the lower esophagus. The general information, postoperative complications, comprehensive treatment, and short-term follow-up results were analyzed.

Results

Among 22 cases, 10 cases (45.5%) underwent R0 resection, and 12 cases underwent R1 resection, including 3 cases of basal margin positive, 9 cases of lateral margin positive; there were 9 cases (40.9%) of T1a-M3 of the pathological type of specimens, and 13 cases (59.1%) of T1b. The follow-up time was 0.9-19.9 months, and the median time was 6 months. 3 cases (13.6%) underwent endoscopic dilatation during esophageal stenosis. In 7 patients who were followed up for surgery, 4 patients received salvage surgery (1 case receiving recurrent surgery after 6 months), and 3 patients received radiotherapy and chemotherapy. Surgical resection was associated with depth of tumor invasion (P = 0.0274) and had no correlation with lesion length (P=0.2659).

Conclusions

ESD combined with chemoradiotherapy can be regarded as a good choice for the treatment of superficial esophageal cancer invading into the muscularis mucosa or submucosa. The resection rate is closely related to the depth of tumor invasion, and is not related to the length of the lesion.

Key words: Superficial esophageal cancer, Muscularis mucosa, Submucosa, Endoscopic submucosal dissection, Short-term result

表1 一般病例资料

临床特征			例数(%)
性别			?
?	男性		18(81.8)
?	女性		4(18.2)
年龄(岁，±s)			65.9±9.0
肿瘤位置			?
?	食管中段		16(72.7)
?	食管下段		6(27.3)
病变长度(cm，±s)			2.3±1.1
肿瘤病理亚型			?
?	T1a M3		9(40.9)
?	T1b		13(59.1)
手术切除情况			?
?	R0		10(45.5)
?	R1		12(54.5)
?	?	基底缘阳性	?
?	?	侧切缘阳性	?
术后随访时间(月，中位数)			6.0
术后再治疗			?
?	复发后挽救性手术		1(4.5)
?	挽救性手术		3(13.6)
?	放化疗		3(13.6)
食管狭窄扩张			3(13.6)

表1 一般病例资料

临床特征			例数(%)
性别			?
?	男性		18(81.8)
?	女性		4(18.2)
年龄(岁，±s)			65.9±9.0
肿瘤位置			?
?	食管中段		16(72.7)
?	食管下段		6(27.3)
病变长度(cm，±s)			2.3±1.1
肿瘤病理亚型			?
?	T1a M3		9(40.9)
?	T1b		13(59.1)
手术切除情况			?
?	R0		10(45.5)
?	R1		12(54.5)
?	?	基底缘阳性	?
?	?	侧切缘阳性	?
术后随访时间(月，中位数)			6.0
术后再治疗			?
?	复发后挽救性手术		1(4.5)
?	挽救性手术		3(13.6)
?	放化疗		3(13.6)
食管狭窄扩张			3(13.6)

表2 ESD患者手术切除情况与肿瘤浸润深度和病变长度的关系

手术切除情况	肿瘤浸润深度[例(%)]		病变长度(cm，±s)
手术切除情况	T1a M3	T1b?	病变长度(cm，±s)
R0切除(10例)	7(70.0)	3(30.0)	2.6±0.8
R1切除(12例)	2(16.7)	10(83.3)	2.0±1.3
统计量	?	t＝1.1445	?
P值	0.0274	0.2659	?

表2 ESD患者手术切除情况与肿瘤浸润深度和病变长度的关系

手术切除情况	肿瘤浸润深度[例(%)]		病变长度(cm，±s)
手术切除情况	T1a M3	T1b?	病变长度(cm，±s)
R0切除(10例)	7(70.0)	3(30.0)	2.6±0.8
R1切除(12例)	2(16.7)	10(83.3)	2.0±1.3
统计量	?	t＝1.1445	?
P值	0.0274	0.2659	?

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Retrospective analysis of short-term results of endoscopic submucosal dissection in the treatment of superficial esophageal cancer invading into the muscularis mucosa or submucosa

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Retrospective analysis of short-term results of endoscopic submucosal dissection in the treatment of superficial esophageal cancer invading into the muscularis mucosa or submucosa