Rice T W, Falk G W, Achkar E, Petras R E
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio.
Am J Gastroenterol. 1993 Nov;88(11):1832-6.
The role of surgery in patients with Barrett's esophagus and high-grade dysplasia is controversial. The aims of this study were to determine the prevalence of unsuspected early cancer and to evaluate surgical outcome in a cohort of patients with high-grade dysplasia. Records of all 16 patients who underwent esophagectomy for high-grade dysplasia from 1986 to 1991 were reviewed. All had preoperative endoscopy with no gross evidence of carcinoma, and none had a preoperative diagnosis of intramucosal or invasive carcinoma. Intramucosal carcinoma was found in six (38%) resection specimens. There were no cases of invasive carcinoma or lymph node metastases. One patient (6%) died 3 months postoperatively. The remaining patients are alive without evidence of recurrent cancer (range of follow-up, 2-68 months). Early postoperative complications occurred in seven patients (44%). Late complications occurred in 11 patients (73%). Anastomotic strictures accounted for seven of the 11 (64%) late complications. Complications were successfully managed conservatively in all but two patients. One required laryngectomy for chronic aspiration and another required a gastrojejunostomy for gastric outlet obstruction. Intramucosal carcinoma that had been unsuspected is frequently found in patients with Barrett's esophagus and high-grade dysplasia. Mortality associated with esophagectomy is low, and perioperative complications can usually be managed conservatively. Esophageal resection is indicated in appropriately selected patients with Barrett's esophagus and high-grade dysplasia.
手术在巴雷特食管和高级别异型增生患者中的作用存在争议。本研究的目的是确定未被怀疑的早期癌症的患病率，并评估一组高级别异型增生患者的手术结果。回顾了1986年至1991年期间因高级别异型增生接受食管切除术的所有16例患者的记录。所有患者术前内镜检查均未发现明显癌证据，且术前均未诊断为黏膜内癌或浸润性癌。在6例（38%）切除标本中发现了黏膜内癌。没有浸润性癌或淋巴结转移病例。1例患者（6%）术后3个月死亡。其余患者存活，无癌症复发迹象（随访时间为2 - 68个月）。7例患者（44%）发生了早期术后并发症。11例患者（73%）发生了晚期并发症。11例晚期并发症中有7例（64%）是吻合口狭窄。除2例患者外，所有并发症均通过保守治疗成功处理。1例因慢性误吸需要行喉切除术，另1例因胃出口梗阻需要行胃空肠吻合术。在巴雷特食管和高级别异型增生患者中经常发现未被怀疑的黏膜内癌。食管切除术相关的死亡率较低，围手术期并发症通常可以通过保守治疗处理。对于适当选择的巴雷特食管和高级别异型增生患者，建议行食管切除术。
