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目的 探讨氩离子凝固治疗法 (APC)对食管癌前病变的治疗作用。方法 对 2头猪食管和 2份人离体新鲜食管标本进行不同功率、距离、时间、黏膜下注药组合的APC凝固治疗 ,光镜下观察组织破坏深度 ,探索可应用到临床的合理治疗参数组合 ,进而对 2 8例食管癌前病变病人施以APC治疗。分别于术后 1,3,6个月 ,以后每年复查常规内镜、色素内镜及病理。结果 APC凝固治疗的创面颜色呈白色黄褐色棕黑色的渐进性变化 ,组织破坏深度随颜色的变化呈渐进性加深。统计学分析结果 ,APC法组织破坏深度随功率增大、作用时间的延长而加深 ,随距离增大、黏膜下注射药物而变浅。临床 2 8例病例中 2 7例治疗后病灶消失 ,病理结果为炎症 ;1例病灶累及食管全周经APC治疗 3次后病灶缩小至 1/ 3,活检病理检查为鳞状上皮不典型增生Ⅱ ,Ⅲ级。结论 APC法是治疗食管癌前病变的有效、简便、安全的新方法 ,可作为食管癌前病变有效的局部阻断治疗方法推广使用。黏膜下注射药物能保证治疗顺利、安全 ,是内镜APC治疗方法的重大改进。
Objective To investigate the therapeutic effect of argon plasma coagulation (APC) on esophageal precancerous lesions. Methods Two pig esophageal and two human fresh esophageal specimens were treated with APC coagulation with different power, distance, time and submucosal injection. The depth of tissue destruction was observed under light microscope, and the reasonable treatment parameters suitable for clinical application 28 patients with esophageal precancerous lesions were treated with APC. Respectively 1,3,6 months after surgery, after each review of conventional endoscopy, endoscopy and pathology. Results The color of the wounds of APC coagulation treatment was white, yellowish brown and brownish brown. The depth of tissue destruction deepened progressively with the change of color. Statistical analysis showed that the damage depth of the APC method deepened with the increase of the power and the extension of the action time. With the increase of the distance, the submucosal injection became lighter. Clinical 28 cases of 27 cases of lesions disappeared, the pathological results of inflammation; 1 case of lesions involving esophageal APC treatment 3 times after the lesion narrowed to 1/3, the biopsy was squamous cell atypical hyperplasia Ⅱ , Ⅲ grade. Conclusion APC is an effective, simple and safe new method for the treatment of esophageal precancerous lesions. It can be used as an effective local block treatment for esophageal precancerous lesions. Submucosal injection of drugs to ensure the smooth treatment, safety, endoscopic APC treatment is a major improvement.