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目的比较早期食管癌及癌前病变患者行内镜下黏膜剥离术(ESD)与外科手术的治疗效果,探讨ESD术后是否需要二次行食管癌根治术的影响因素。方法回顾性分析2011年7月至2015年6月南京医科大学第一附属医院消化内科收治的215例早期食管病变患者和胸外科收治的208例术后病理提示为T1期食管癌及癌前病变患者,通过术后常规病理结果比较内镜治疗与外科手术的治疗效果。结果内镜下ESD术患者术前均做超声内镜检查排除了淋巴结转移,共切除227个病灶,均一次完整剥离,剥离成功率为100.0%。ESD术后病理:34个病灶切缘阳性,切缘阳性率为15.81%;于胸外科追加食管切除手术患者20例。外科手术患者行传统开放手术121例,微创手术87例,所有病灶均一次完全切除。外科手术术后病理:208个病灶完全切除,切除成功率100%,39例发生淋巴结转移,转移率18.75%,10例(4.81%)出现脉管内癌栓。结论食管癌T0~T1a期且切缘为阴性的患者,内镜ESD治疗有效,可代替外科手术。对T1a期以上、ESD术后切缘阳性、术后病理发现癌变组织以及术前胃镜提示病变长度≥3 cm,环食管周2/3以上,癌细胞呈中、低分化者,推荐行外科手术治疗。
Objective To compare the therapeutic effect of endoscopic mucosal dissection (ESD) and surgical operation in patients with early esophageal cancer and precancerous lesions and to explore the influencing factors of esophageal cancer radical mastectomy after ESD. Methods A retrospective analysis of 215 patients with early esophageal lesions admitted to Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University from July 2011 to June 2015 and 208 patients admitted to thoracic surgery were retrospectively analyzed. The pathological findings were T1 esophageal cancer and precancerous lesions Patients, compared with routine pathological results after endoscopic treatment and surgical treatment. Results All patients underwent endoscopic ultrasonography under endoscopic ultrasonography to rule out lymph node metastasis. A total of 227 lesions were excised. All of them were completely stripped and the success rate of stripping was 100.0%. ESD pathology: 34 lesions positive margins, positive margins of 15.81%; in thoracic surgery additional esophagectomy in 20 patients. Surgical patients underwent traditional open surgery in 121 cases, minimally invasive surgery in 87 cases, all lesions were completely removed. Surgical postoperative pathology: 208 lesions were completely resected, the successful rate of resection was 100%, lymph node metastasis in 39 cases, metastasis rate was 18.75%, and thrombosis in the vessel occurred in 10 cases (4.81%). Conclusion In patients with T0 ~ T1a stage of esophageal cancer and negative margins, endoscopic ESD treatment is effective and can replace surgery. On T1a and above, the positive margins of ESD after surgery, postoperative pathological findings of cancerous tissue and preoperative gastroscopy tip length ≥ 3 cm, 2/3 of the ring esophageal circumference, cancer cells were moderately differentiated, recommended surgical treatment treatment.