多波段黏膜切除术治疗食管鳞状上皮内瘤变的临床价值。

Clinical value of multiband mucosectomy for the treatment of squamous intraepithelial neoplasia of the esophagus.

机构信息

Department of Gastroenterology, Tengzhou Central People's Hospital of Jining Medical College, Shandong province, China.

出版信息

J Gastroenterol Hepatol. 2013 Apr;28(4):650-5. doi: 10.1111/jgh.12111.

DOI:10.1111/jgh.12111

PMID:23301863

Abstract

BACKGROUND AND AIM

To evaluate the clinical value of multiband mucosectomy (MBM) for the treatment of squamous intraepithelial neoplasia of the esophagus.

METHODS

A total of 51 lesions located at esophagus from 43 patients were treated with MBM, among which 11 were diagnosed as middle-grade intraepithelial neoplasia, 25 as high-grade intraepithelial neoplasia, and 15 as early esophageal cancer pathologically. Primary end-points were the rate of complete endoscopic resection and the mean operation time; the second end-points were the postoperative local recurrence rate and acute plus early complications. The histopathological results were compared between pre-MBM biopsy and MBM specimens. All patients were followed up endoscopically.

RESULTS

A total of 52 MBM procedures with 180 resections were performed in 43 patients. The complete endoscopic resection was achieved in 92.3% (95% confidence interval [CI] 81.8-96.9%). The sizes of the lesions ranged from 10 × 8 mm to 25 × 23 mm. The mean operation time is 37 ± 5 min. The operative acute bleeding complication was 7.6% (95% CI 3-18.1%); no perforations occurred. Early complications consisted of delayed bleeding (one patient 1.9%; 95% CI 0.3-10.1%) and slight esophageal stenosis (one patient). The histopathological diagnosis of 26 cases (51%) was consistent between biopsy and MBM samples, while 20 lesions exhibited higher grade dysplasia. The local recurrence rate was 6.9% (3/43) at 1 year, 9.3% (4/43) at 2 years, and 9.3% at 2.5 years. No death occurred during follow-up.

CONCLUSIONS

MBM is a safe and effective technique for the treatment of early esophageal cancer and precancerous lesions.

摘要

背景与目的

评估多带黏膜切除术（MBM）治疗食管鳞状上皮内瘤变的临床价值。

方法

对 43 例患者的 51 处食管病变进行 MBM 治疗，其中 11 例病理诊断为中级别上皮内瘤变，25 例为高级别上皮内瘤变，15 例为早期食管癌。主要终点为完全内镜切除率和平均手术时间；次要终点为术后局部复发率和急性及早期并发症。比较 MBM 术前活检和 MBM 标本的组织病理学结果。所有患者均行内镜随访。

结果

43 例患者共进行 52 次 MBM 手术，共 180 次切除。92.3%（95%可信区间 81.8-96.9%）的患者达到完全内镜切除。病变大小为 10×8mm 至 25×23mm。平均手术时间为 37±5min。手术急性出血并发症发生率为 7.6%（95%可信区间 3-18.1%）；无穿孔发生。早期并发症包括迟发性出血（1 例 1.9%；95%可信区间 0.3-10.1%）和轻度食管狭窄（1 例）。26 例（51%）的活检与 MBM 标本的组织病理学诊断一致，而 20 处病变显示高级别异型增生。1 年、2 年和 2.5 年的局部复发率分别为 6.9%（3/43）、9.3%（4/43）和 9.3%。随访期间无死亡病例。