目的:探讨电子胃镜在下咽鳞状细胞癌合并食管鳞状细胞癌(以下简称鳞癌)及癌前病变的检查中的临床应用。方法:总结2018年1月至2020年12月青岛大学附属医院278例下咽鳞癌患者行电子胃镜的检查结果,其中男271例,女7例;年龄41~91岁。所有患者均无食管和胃的占位性病变史。根据电子胃镜的检查和活检病理结果,进一步明确术前诊断,并拟定个体化的治疗方案。结果:278例下咽癌患者中,电子胃镜及活检同期发现食管鳞癌及癌前病变60例(21.6%),其中男58例,女2例;食管鳞癌49例,食管中—重度不典型增生11例。60例患者中,11例放弃手术治疗,8例行内镜粘膜下剥离术(ESD)后再行手术,21例行一期喉、下咽全切除术 + 局部带蒂皮瓣转移修复术,15例行一期喉、下咽、食管全切除术 + 胃上提咽胃吻合术,5例行一期喉、下咽全切及颈段食管切除 + 游离空肠移植修复。结论:下咽鳞癌同期发生食管鳞癌的概率较高,电子胃镜检查能有效发现食管及胃的癌及癌前病变,可以提供更为准确的个体化治疗方案。 Objective: To explore the clinical application of electronic gastroscopy in the examination of hypopharyngeal squamous cell carcinoma complicated with esophageal squamous cell carcinoma (hereinafter referred to as squamous cell carcinoma) and precancerous lesions. Methods: To summarize the results of 278 patients with hypopharyngeal squamous cell carcinoma treated with electronic gastroscopy in the Affiliated Hospital of Qingdao University from January 2018 to December 2020, including 271 males and 7 females. All patients aged from 41 to 91 years old had no history of esophageal and gastric space occupying diseases. According to the electronic gastroscopy examination and biopsy pathological results, the preoperative diagnosis was further determined, and the results of individualized treatment plan were formulated. Among 278 patients with hypopharyngeal cancer, 60 cases (21.6%) of esophageal squamous cell carcinoma and precancerous lesions were found by electronic gastroscopy and biopsy at the same time, including 58 males and 2 females. Among the 60 patients, 11 gave up surgical treatment, 8 underwent endoscopic submucosal dissection (ESD) followed by surgery, 21 underwent one-stage total laryngopharyngeal resection + local pedicled skin flap transfer repair, and 15 underwent one-stage laryngopharyngeal resection. Conclusion: The simultaneous occurrence of esophageal squamous carcinoma in hypopharyngeal squamous carcinoma is highly likely. Electronic gastroscopy can effectively detect cancer and precancerous lesions of esophagus and stomach, and can provide a more accurate and personalized treatment plan.
下咽癌,食管癌,电子胃镜
Xiukai Zhao1,2, Jie Qiu2*
1Qingdao University, Qingdao Shandong
2The Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Dec. 11th, 2021; accepted: Jan. 1st, 2022; published: Jan. 14th, 2022
Objective: To explore the clinical application of electronic gastroscopy in the examination of hypopharyngeal squamous cell carcinoma complicated with esophageal squamous cell carcinoma (hereinafter referred to as squamous cell carcinoma) and precancerous lesions. Methods: To summarize the results of 278 patients with hypopharyngeal squamous cell carcinoma treated with electronic gastroscopy in the Affiliated Hospital of Qingdao University from January 2018 to December 2020, including 271 males and 7 females. All patients aged from 41 to 91 years old had no history of esophageal and gastric space occupying diseases. According to the electronic gastroscopy examination and biopsy pathological results, the preoperative diagnosis was further determined, and the results of individualized treatment plan were formulated. Among 278 patients with hypopharyngeal cancer, 60 cases (21.6%) of esophageal squamous cell carcinoma and precancerous lesions were found by electronic gastroscopy and biopsy at the same time, including 58 males and 2 females. Among the 60 patients, 11 gave up surgical treatment, 8 underwent endoscopic submucosal dissection (ESD) followed by surgery, 21 underwent one-stage total laryngopharyngeal resection + local pedicled skin flap transfer repair, and 15 underwent one-stage laryngopharyngeal resection. Conclusion: The simultaneous occurrence of esophageal squamous carcinoma in hypopharyngeal squamous carcinoma is highly likely. Electronic gastroscopy can effectively detect cancer and precancerous lesions of esophagus and stomach, and can provide a more accurate and personalized treatment plan.
Keywords:Hypopharyngeal Cancer, Esophageal Cancer, Electronic Gastroscopy
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
下咽癌是起源于喉咽部的一种恶性肿瘤,在所有头颈部肿瘤中大约占6.5%,是头颈部鳞状细胞癌(以下简称鳞癌)中预后最差的恶性肿瘤 [
2018年1月~2020年12月我院收治的下咽癌患者,除不能接受电子胃镜检查者、肿瘤体积较大进镜困难者,术前均行电子胃镜检查。回顾分析278例患者临床资料及电子胃镜检查结果,患者年龄41~91岁,男271例,女7例。根据2010年AJCC标准分期:I期3例,II期37例,III期90例,IV期148例(表1)。其中电子胃镜检查发现食管癌及癌前病变60例,下咽癌累及颈段食管者43例,下咽癌合并中、下段食管癌及癌前病变者17例。
N0 | N1 | N2 | N3 | ||
---|---|---|---|---|---|
T1 | 3 | 4 | 1 | 0 | 8 |
T2 | 37 | 17 | 22 | 2 | 78 |
T3 | 32 | 37 | 76 | 10 | 155 |
T4 | 5 | 6 | 21 | 5 | 37 |
合计 | 77 | 64 | 120 | 17 | 278 |
表1. 278例下咽癌患者的肿瘤分期(例)
一、278例下咽癌患者电子胃镜检查共取病理143例,病理证实为食管黏膜慢性炎性改变79例,Barrett食管4例,癌前病变或癌60例。在60例病理证实的食管癌或癌前病变患者中,食管中—重度不典型增生11例,食管鳞癌49例,其中发生在颈段食管者43例,中、下段食管者17例。所有下咽癌合并食管癌及癌前病变的患者中,双原发癌51例,三原发癌7例,四原发癌2例。
二、在60例通过电子胃镜查出的下咽癌合并食管癌或癌前病变患者中,除11例患者放弃手术治疗外,对其余49例患者进行了治疗方案的调整:8例患者食管病变表浅且面积较小,行内镜下肿瘤黏膜下剥离术,术后一段时间内行保留或不保留喉功能的下咽癌切除术;5例下咽癌合并颈段食管病变患者,一期行喉、下咽全切及颈段食管切除 + 游离空肠移植修复术;15例下咽癌合并食管癌患者行一期喉、下咽、食管全切除术 + 胃上提咽胃吻合术;21例不宜行食管病变切除及拒绝同期行食管癌病变患者,行喉、下咽全切除术 + 局部带蒂皮瓣转移修复术。
三、3个月后对经过胃镜检查证实的下咽癌合并食管癌或癌前病变患者进行预后追踪,49例经手术治疗患者均进行手术后放化疗,其中41例患者恢复经口流质饮食,8例患者因吻合口狭窄行鼻胃(肠)管或空肠造瘘营养管进食;11例非手术治疗患者中,7例行放化疗,其中4例因进食差行鼻胃管或胃造瘘,4例放弃治疗。1年后对60例患者预后进行追踪,49例手术患者中13例患者发现颈部淋巴结及远处转移复发,2例死亡;11例非手术治疗患者中,6例患者死亡。
下咽癌的治疗,随着综合治疗的增强和手术方式的改进,有了明显的进展。下咽癌的原发病灶及颈部淋巴结转移灶的控制也得到明显提高 [
电子胃镜在下咽癌术前检查中的应用,使得多原发癌的检出得以提高 [
根据电子胃镜的检查对下咽癌患者进行食管肿瘤筛查及调整治疗方式,可提高多原发癌的检出,同时在短时间(1年内)一定程度上提高肿瘤患者的生存率。但后续还需要对患者进行3年、5年甚至更远期生存及治疗的追踪,总结电子胃镜检查对患者长期预后的临床应用价值。
赵修凯,邱 杰. 电子胃镜在下咽合并食管鳞状细胞癌检查中的临床应用Clinical Application of Electronic Gastroscope in the Examination of Hypopharynx Complicated with Esophageal Squamous Cell Carcinoma[J]. 临床医学进展, 2022, 12(01): 157-160. https://doi.org/10.12677/ACM.2022.121024