Objective: To evaluate the usefullness of flexible esophagoscopy and chromoendoscopy with Lugol's solution in the detection of synchronous esophageal neoplasm in patients with hypopharyngeal squamous cell carcinoma (HSCC). Methods: A retrospective review of 96 cases with HSCC that received surgical treatment from March 2016 to March 2017 was accomplished. In these patients, the site of origin were pyriform sinus (n=75), posterior pharyngeal wall (n=11) and postcricoid (n=10). Esophagoscopy was prospectively performed on all patients before treatment for HSCC. All patients underwent conventional white-light endoscopic examination with Lugol chromoendoscopy and narrow band image. Suspicious areas of narrow band image or Lugol-voiding lesions were observed and biopsied. The treatment strategy of primary HSCC was modified according to the presence of synchronous esophageal squamous cell neoplasms by a multidisciplinary approach. Results: Ninety-six patients were enrolled (age ranging from 37-80 years). All patients did not have previous treatment.Histopathological analysis revealed middle to high-grade dysplasia in 5 cases, Tis cancer in 5 cases, cancer in 16 cases and inflammation or normal findings in the others. Four cases were treated with endoscopic submucosal dissection before hypopharygeal surgery, 3 cases with lower esophageal cancers were treated with gastric pull-up combined with free jejunal flap after total circumferential pharyngolaryngectomy (TCPL) and certical esophagectomy, and 14 cases were treated with TCPL, total esophagectomy and gastric pull-up. Conclusions: Esophagoscopy is a feasible and justified procedure in HSCC cases as it enhances the detection of premalignant lesion or second primary cancer. Routine esophagoscopy for detecting synchronous second primary tumor should be recommended for patients with HSCC. The treatment strategy for primary HSCC is modified according to the presence of synchronous second primary tumor.
目的： 探讨电子胃镜在下咽鳞状细胞癌(以下简称鳞癌)术前检查中的临床应用价值。 方法： 总结2016年3月至2017年3月山东大学附属省立医院96例下咽鳞癌患者术前行电子胃镜检查的结果，其中男93例，女3例；年龄37～80岁，中位年龄68岁。原发病变为梨状窝癌75例，下咽后壁癌11例，环后癌10例；TNM分期：Ⅱ期12例，Ⅲ期32例，Ⅳ期52例。所有患者均无食管和胃的占位性病变史，术前均行电子胃镜下的食管和胃的检查，包括白光下观察、窄带成像(NBI)检查和卢戈液染色，以及可疑病变区域的活检。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，并制定个体化的手术治疗方案。 结果： 96例下咽鳞癌患者中，电子胃镜下行食管和/或胃部活检共56例，病理诊断证实为食管及胃癌前病变或癌者共26例(27.1%)，其中食管中－重度非典型增生5例，食管原位癌5例，食管鳞癌15例，胃腺癌1例。在15例食管鳞癌中1例为贲门鳞癌累及胃底。26例患者中5例放弃治疗，4例行内镜下食管肿瘤黏膜内切除术后再行下咽癌手术，14例一期行喉、下咽、食管全切除＋胃上提胃咽吻合术，2例一期行喉、下咽全切除及颈段食管切除＋游离空肠移植修复＋下段食管切除胃食管吻合术，1例一期行喉、下咽全切除及颈段食管切除＋游离空肠移植修复＋下段食管及胃部分切除胃食管吻合术。 结论： 下咽癌同期发生食管第二原发癌的概率较高，电子胃镜检查能够有效地发现食管和胃的癌及癌前病变，为患者提供更为准确的术前诊断和更为精确的个体化手术治疗方式。.
Keywords: Esophageal neoplasms; Gastroscopy; Hypopharyngeal neoplasms.