目的 研究与分析放大内镜在内镜下黏膜剥离术（ESD）治疗食管早期癌及癌前病变中的作用。方法 选取2020年1月—2022年7月我院收治的明确诊断为食管癌的患者为观察对象,研究者为其一级亲属40岁以上经普通内镜发现食管异常病灶同时行放大内镜检查者。据疑病处食管黏膜上皮乳头内毛细血管袢（IPCL）变化,判断病变性质估计侵犯深度。疑早期食管癌及癌前病变者行ESD治疗,疑进展期食管癌者行外科手术治疗,送整体标本病理检查。结果 食管癌一级亲属40岁以上患者经普通内镜发现食管异常病灶同时行放大内镜检查者共128例,其中行ESD和外科手术取得整体病理标本102例。对比放大胃镜术前判断和术后整体病理标本,判断性质方面放大内镜对食管早期病变诊断的总体准确率为87.3%,诊断食管早期鳞癌的灵敏度为97.8%,特异度为15.4%,阳性预测值88.8%,阴性预测值50%。判断浸润层次方面,放大内镜对食管早期鳞癌深度诊断的总体准确率为69%,B1型血管对浸润深度正确诊断率为90.6%,灵敏度为70.6%,B2型血管对浸润深度正确诊断为32.2%,灵敏度为76.9%,B3型血管对浸润深度正确诊断为66.7%,灵敏度为33.3%。结论 放大内镜在ESD下治疗食管早期鳞癌及癌前病变患者,可对食管病变性质准确判断,提升病变检出率,实践价值较高。

Objective To investigate and analyze the role of magnifying endoscopy in endoscopic submucosal dissection（ESD）in the treatment of early esophageal cancer and precancerous lesions．Methods Esophageal cancer patients in our hospital from January 2020 to July 2022 were selected as the observation objects,the investigator was a first-degree relative over 40 years old who found abnormal esophageal lesions through ordinary endoscopy,and underwent magnifying endoscopy,according to suspected esophageal mucosal epithelial nipple capillary loop（IPCL）changes,defined the nature of the lesion to estimate the invasion depth．Patients with suspected early esophageal cancer and precancerous lesions were given ESD treatment,and those with suspected progressive esophageal cancer underwent surgical treatment,and were sent to the whole specimen for pathological examination．Results A total of 128 patients with first-degree relatives of esophageal cancer over 40 years old were found to have simultaneous enlarged endoscopy simultaneously through common endoscopy,among which 102 patients had obtained overall pathological specimens by ESD and surgery．Comparing the preoperative diagnosis of magnifying gastroscopy and the postoperative overall pathological specimens,the overall accuracy of magnifying endoscopy for the diagnosis of early esophageal lesions was 87.3%,the sensitivity of detecting early esophageal squamous cell carcinoma was 97.8%,specificity was 15.4%,the positive predictive value was 88.8%,and the negative predictive value was 50%．In terms of invasion level,the overall accuracy of magnifying endoscopy for the depth diagnosis of early esophageal squamous cell carcinoma was 69%,90.6% accuracy and 70.6% sensitivity of B1 vessels,32.2% and 76.9% of B2 vessels,66.7% and 33.3% of B3 vessels．Conclusions The magnifying endoscopic treatment of patients with early esophageal cancer and precancerous lesions under ESD can accurately diagnosis the nature of esophageal lesions,improve the detection rate of lesions,and has high practical value．

目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

目的 分析上消化道早癌与癌前病变内镜下治疗的效果。方法 将2017年10月—2020年10月接诊且行传统外科手术治疗的75例上消化道早癌与癌前病变患者作为对照组,将同期接诊且行内镜黏膜下剥离术(ESD)治疗的75例上消化道早癌与癌前病变患者作为观察组,对组间围手术期指标、生活质量、疼痛评分、病灶切除情况、治疗效果、并发症发生率展开分析。结果 (1)观察组术中出血量(17.66±2.25)mL、手术用时(96.79±9.25)min、住院时间(10.95±1.88)d、治疗费用(1.74±0.41)万元均少于对照组(87.73±5.63)mL、(190.52±10.68)min、(22.75±2.69)d、(4.96±0.37)万元(P<0.05);(2)组间生活质量、疼痛评分在术前无差异(P>0.05);观察组生活质量、疼痛评分在术后优于对照组(P<0.05);(3)观察组治愈性切除率(98.67%)、整块完整切除率(100.00%)与对照组(96.00%、98.67%)无差异(P>0.05);(4)观察组总有效率(96.00%)与对照组(97.33%)无明显差异(P>0.05);(5)观察组发生2例并发症(2.67%),对照组发生11例并发症(14.67%,P<0.05)。结论 对上消化道早癌与癌前病变患者行ESD治疗,疗效显著,可以减少并发症,减轻疼痛感与经济压力,改善生活质量,值得推广。

Objective To analyze the effect of endoscopic treatment of early upper gastrointestinal cancer and precancerous lesions. Methods From October 2017 to October 2020, 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by traditional surgery were selected as the control group, and 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by endoscopic submucosal dissection (ESD) were selected as the observation group. The therapeutic effect and the incidence of complications were analyzed. Results (1) The intraoperative blood loss was (17.66±2.25) mL, operation time was (96.79±9.25) min, hospitalization time was (10.95±1.88) d, treatment cost was(17.4±4.1)thousand yuan in the observation group, which were less than those in the control group [(87.73±5.63) mL, (190.52±10.68) min, (22.75±2.69) d, (49.6±3.7) thousand yuan, (P＜0.05)]. (2) There were no significant differences in quality of life and pain score between groups before operation. The quality of life and pain score of the observation group were better than those of the control group after operation (P<0.05). (3) The curative resection rate (98.67%) and complete resection rate (100.00%) of the observation group were not significantly different from those of the control group (96.00% and 98.67%,P＞0.05); (4) The total effective rate (96.00%) of the observation group was not significantly different from that of the control group (97.33%,P＞0.05); (5) The total effective rate of the observation group was significantly higher than that of the control group (97.33%). There were 2 cases of complications in the observation group (2.67%), and 11 cases in the control group (14.67%, P<0.05). Conclusion ESD treatment for patients with early upper gastrointestinal cancer and precancerous lesions has significant effect, can reduce complications, relieve pain and economic stress, and improve the quality of life, which is worthy of promotion.