内镜下黏膜下剥离术治疗浅表性食管肿瘤对肝硬化患者是可行的且风险不高。
Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis.
作者信息
Tsou Yung-Kuan, Liu Chia-Yuan, Fu Kuang-I, Lin Cheng-Hui, Lee Mu-Shien, Su Ming-Yao, Ohata Ken, Chiu Cheng-Tang
机构信息
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
出版信息
Dig Dis Sci. 2016 Dec;61(12):3565-3571. doi: 10.1007/s10620-016-4342-8. Epub 2016 Oct 21.
BACKGROUND
Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients.
AIM
To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients.
METHODS
Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs).
RESULTS
Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD.
CONCLUSION
Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction.
背景
食管内镜黏膜下剥离术（ESD）治疗肝硬化患者的报道很少。
目的
报告ESD治疗肝硬化患者浅表食管肿瘤（SENs）的结果。
方法
回顾性分析40例连续接受46次ESD治疗的50个SENs患者。肝硬化组包括8例（11个SENs）肝硬化患者，其中6例为Child-Pugh A级肝硬化，2例为B级肝硬化。4例（6个SENs）合并食管静脉曲张。比较肝硬化患者与非肝硬化对照组（32例，39个SENs）的参数。
结果
肝硬化组血小板计数显著降低，而国际标准化比值显著升高。比较肝硬化组和非肝硬化组，平均肿瘤长度（4 vs. 3.7 cm，p = 0.56）和中位手术时间（15.1 vs. 11.5 min/cm，p = 0.30）相似。整块切除率分别为81.8%和89.7%（p = 0.60）。在肝硬化组中，未整块切除的病变均为食管静脉曲张患者。肝硬化组和非肝硬化组的黏膜下病变率分别为54.5%和25.6%（p = 0.064），而R0切除率分别为77.8%和94.3%（p = 0.16）。肝硬化组2例未行R0切除的病变因黏膜下浸润而垂直切缘阳性但水平切缘阴性。肝硬化患者术中出血比非肝硬化患者更频繁（18.2% vs. 0%，p = 0.045）。所有患者均未发生食管穿孔、术后出血或与ESD相关的死亡。
结论
食管ESD似乎对肝硬化患者是安全有效的，尤其是那些没有严重肝功能障碍的患者。
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