伴有高级别异型增生的巴雷特食管。预防性食管切除术的指征。
Barrett's esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy.
作者信息
Heitmiller R F, Redmond M, Hamilton S R
机构信息
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-5674, USA.
出版信息
Ann Surg. 1996 Jul;224(1):66-71. doi: 10.1097/00000658-199607000-00010.
OBJECTIVE
The authors review the results and outcomes of esophagectomy (prophylactic esophagectomy) for patients with Barrett's esophagus and high-grade epithelial dysplasia (HGD).
SUMMARY BACKGROUND DATA
The role of prophylactic esophagectomy for Barrett's esophagus with HGD is controversial, with some authors recommending surgery and others favoring endoscopic surveillance until biopsy diagnosis of carcinoma is made.
METHODS
Between 1982 and 1994, 30 consecutive patients with HGD underwent esophagectomy and had the pre- and postoperative pathology reviewed at our institution. The medical records were reviewed to determine patient characteristics, preoperative endoscopic data, surgical approach, operative morbidity and mortality, length of hospitalization, and treatment outcome. Patients were divided into two groups based on whether invasive adenocarcinoma was found in the resection specimen (group 1) or not (group 2).
RESULTS
The duration of reflux symptoms was 22 +/- 14 years for group 1 and 9 +/- 11 years for group 2 (p = 0.05). There was one operative death (3.3%) and six complications (20%). In 13 patients (43%, group 1), invasive adenocarcinoma was found in the resected esophagus. The American Joint Committee on Cancer stage for these patients was stage I (8 patients), stage II (2 patients), and stage III (3 patients). One stage I patient died of adenocarcinoma (72 months) in an incompletely excised HGD segment. Other stage I and II patients are alive without adenocarcinoma with an 18-and 63-month mean follow-up, respectively. Outcome for stage III patients was one operative death, one noncancer death (6 months), and one patient with metastatic adenocarcinoma (26 months). For group 2 (57%), there were no adenocarcinoma deaths (40 months).
CONCLUSIONS
High-grade epithelial dysplasia is an indication for esophagectomy because of the prevalence of occult adenocarcinoma (43%). Esophagectomy can be performed safely, and survival in patients with completely resected Barrett's esophagus and early-stage adenocarcinoma is excellent.
目的
作者回顾了对巴雷特食管合并高级别上皮内瘤变（HGD）患者行食管切除术（预防性食管切除术）的结果和转归。
总结背景资料
预防性食管切除术对巴雷特食管合并HGD的作用存在争议，一些作者推荐手术，而另一些作者则倾向于内镜监测，直至活检诊断为癌。
方法
1982年至1994年，30例连续的HGD患者接受了食管切除术，并在我们机构对其术前和术后病理进行了复查。回顾病历以确定患者特征、术前内镜检查数据、手术方式、手术并发症和死亡率、住院时间以及治疗结果。根据切除标本中是否发现浸润性腺癌将患者分为两组（第1组）或未发现（第2组）。
结果
第1组反流症状持续时间为22±14年，第2组为9±11年（p = 0.05）。有1例手术死亡（3.3%）和6例并发症（20%）。在13例患者（43%，第1组）中，切除的食管中发现了浸润性腺癌。这些患者的美国癌症联合委员会分期为I期（8例患者）、II期（2例患者）和III期（3例患者）。1例I期患者在未完全切除的HGD节段死于腺癌（72个月）。其他I期和II期患者存活，无腺癌，平均随访时间分别为18个月和63个月。III期患者的转归为1例手术死亡、1例非癌症死亡（6个月）和1例有转移性腺癌患者（26个月）。对于第2组（57%），无腺癌死亡（40个月）。
结论
由于隐匿性腺癌的发生率（43%），高级别上皮内瘤变是食管切除术指征。食管切除术可以安全进行，完全切除巴雷特食管和早期腺癌患者的生存率极佳。
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