食道癌EMR,ESD(燕达医院)课件.ppt

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1、燕达国际医院消化科郑日男CARCINOMAOFTHEESOPHAGUS内镜发展史1806-硬式内镜---德国法兰克福，Bozzin1957-纤维内镜---美国医生，Hirschowitz1983-电子胃镜---美国，WelchAllyn公司---电视监视器ChromoendoscopyMagnifyingendoscopyIPCLNBI,AFIEMRESDERCPEUSNOTESEsophagealanatomyCe:cervicalesophaguseUt:upperthoracicesophagusMt:middlethorac

2、icesophagusLt:lowerthoracicesophagusAe:AbdominalesophagusEpitheliumLaminaprop.MascularismucosaeSubmucosaProp.muscleSerosam1m2m3sm1sm2sm3Depthoftumorinvasion正常食管组织病理EpitheliumLaminapropriaMuscularismucosaeCircularmuscleLongitudinalmuscleSubmucosaSerosaEpidemiologyofthee

3、sophagealcancerCarcinomaoftheesophagusincidenceNorthchina130/100,000populationAmerica5/100,000populationJapan5/100,000populationUrbanChinaRuralChinaUnitedStatesUnitedKingdomSwitzerland52.4(2001)051015202530354045505531.3(2000)24.9(1999)27.5(1999)5.6(1999)14.7(1999)8.1(

4、1998)17.2(1999)11.6(1999)12.7(1999)8.0(1999)10.0(1999)37.0(2000)11.0(1997)23.7(1999)Mortalityper100,000malesJapanKoreaItalyCanadaGermanyFranceSwedenAustraliaRussiaArgentinaCountryHatakeyamaetal.naturereviewscnacer2004Sep;4(9):688-94食管癌的病理(病変部位)日本Mt:51.5%Lt:22.6%Ut:13.7

5、%中国Mt:52.9-63.33%Lt:24.95-38.92%Ut:2.80-14.10%0type(superficialtype)Itype:superficialandprotrudedtype(>1mm)IItype:superficialandflattypeIIa:slightlyelevatedtype(<1mm)IIb:flattypeIIc:slightlydepressedtype(<0.5mm)IIItype:superficialandexcavatedtype(>0.5mm)Classificationo

6、fearlyesophagealcanceradvancedtype1type:protrudingtype2type:ulcerativeandlocalizedtype3type:ulcerativeandinfiltratingtype4type:diffuselyinfiltratingtype5type:unclassifiabletypeClassificationofadvancedesophagealcancer表浅型食管癌的肉眼分类0-I0-II0-IIIIpIp1IsepIIbIIcIIaIIIpolypoidt

7、ypeplateautypepredominantlysubepithelialtypeslightlyelevatedtypeflattypeslightlydepressedtypesuperficialanddistinctlydepressedtype组织学分类鳞状细胞癌(90%)腺癌:(1)单纯腺癌(2)腺鳞癌(3)粘液表皮样癌(4)腺样囊性癌其他:未分化癌和癌肉瘤食管癌的TNM分期（AJCC，1997）T分期Tis原位癌T1累及粘膜下层T2累及固有肌层T3累及外膜及食管旁组织T4累及临近组织器官ERCP,Choledo

8、choscopyCT,ERCP,EST,ENBDEndoscopicsphincterotomyDiagnosis1)50岁以上的男性2)多饮·吸烟3)头颈部癌或其他脏器的癌4)食管癌的家族史5)腐蚀性食管炎6)贲门失弛缓症7)Bar