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早期食管癌及癌前病变的诊断与内镜下微创治疗

Diagnosis and Minimally Invasive Endoscopic Treatment of Early Esophageal Cancer and Precancerous Lesions

  • 摘要: 食管癌是常见的消化道恶性肿瘤,其预后与早期诊断、治疗密切相关。近年来随着内镜诊治技术的发展,尤其是一些新型内镜诊治技术的突破性进展,早期食管癌及癌前病变的检出率明显提高,越来越多的早期食管癌患者可通过内镜下微创治疗。目前,内镜下黏膜剥离术已经成为早期食管癌及癌前病变的首选治疗方式,其较外科手术创伤小,可保留食管的生理结构,提高患者术后生活质量,且可整块切除病变,并提供精确的术后病理。内镜下微创治疗在不断进展的同时也面临一些新问题,包括如何处理多灶食管黏膜病变、如何在术前准确判断食管病变浸润深度、淋巴结转移风险、如何看待活检与术后病理不一致、如何处理术后的切缘阳性、如何管理术中及术后并发症、特殊人群的治疗、内镜非根治性切除的患者是否追加外科手术及何时追加手术等。本专题针对上述问题进行探讨,以期寻找食管癌前病变及早期癌内镜下治疗的标准化治疗方案和术后并发症的管理策略,改善患者的生存质量及预后。

     

    Abstract: Esophageal cancer is a common malignancy of digestive tract, and its prognosis is closely related to early diagnosis and treatment. In recent years, with the development of endoscopic diagnosis and treatment technology, especially the breakthrough progress of new endoscopic equipments, the detection rate of early esophageal cancer and precancerous lesions is significantly improved, and more and more patients with early esophageal cancer can be treated with minimally invasive endoscopic treatment. At present, endoscopic dissection has become the preferred treatment for early esophageal cancer and precancerous lesions. The advantages is not only less traumatic than traditional surgery, but also retain the physiological structure of esophagus, achieve accurate postoperative pathology and better postoperative quality of life of patients. However, endoscopic minimally invasive treatment in progress also face new problems to be solved, such as how to deal with multifocal esophageal lesions, how to estimate esophageal lesions infiltration depth and lymph node metastasis risk accurately, how to understand the discrepancy between biopsy and postoperative pathology, how to deal with the positive resection margins as well as intraoperative and postoperative complications, how to manage endoscopic treatment of the special subpopulation of the patients, whether and when additional radical surgery should be provided to the patients with non-curative endoscopic treatment, and so on. Aiming to the above problems and the purpose to improve the prognosis and the quality of life of esophageal cancer patients, this topic includes a series studies to explore standardized treatment scheme and management strategy for postoperative complications in the endoscopic treatment of early esophageal cancer and precancerious lesions.

     

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