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

摘要: 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。

Abstract: 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.