Rembacken B J, Gotoda T, Fujii T, Axon A T
Centre for Digestive Diseases, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, United Kingdom.
Endoscopy. 2001 Aug;33(8):709-18. doi: 10.1055/s-2001-16224.
We are now finding more malignancies in their early stages than previously. Attempts to ablate these lesions are difficult and do not provide the histological information required to decide on further treatment. Surgery is difficult to justify, as only a minority of lesions are associated with lymph node metastases and lesions may not become clinically relevant within the lifetime of an elderly patient. Endoscopic mucosal resection allows cancers to be resected at minimal cost, morbidity and mortality. It is also the most reliable investigation when assessing lesions which are suspicious for containing early cancer. After endoscopic removal, histological assessment of depth of penetration and a search for invasion into lymphatics or venules allows the risk of microscopic lymph node metastases to be predicted. The risk of developing metastatic disease can then be balanced against the risks of surgery in view of the patient's age and health.
我们现在发现的处于早期阶段的恶性肿瘤比以前更多。消融这些病变的尝试很困难，并且无法提供决定进一步治疗所需的组织学信息。手术很难说得通，因为只有少数病变会伴有淋巴结转移，而且在老年患者的生存期内，病变可能不会发展到具有临床相关性。内镜黏膜切除术能够以最低的成本、发病率和死亡率切除癌症。在评估疑似包含早期癌症的病变时，它也是最可靠的检查方法。内镜切除后，对浸润深度进行组织学评估以及查找是否侵犯淋巴管或小静脉，可以预测微小淋巴结转移的风险。鉴于患者的年龄和健康状况，发生转移性疾病的风险可以与手术风险相权衡。
