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要旨●当院では1996年より咽頭表在癌へのEMRを開始し,2021年4月までの間に437例710病変の治療を行った.現在は頭頸部外科医と協力し,ELPSを標準的に行っている.筋層・軟骨浸潤のない表在癌でリンパ節転移のないもの,大きさ4cm以下の病変がELPSの適応である.頭頸部癌の既往例や食道癌術後症例は術後の誤嚥性肺炎を発症しやすく,適応を慎重に決める必要がある.部位に関しては舌根や喉頭蓋舌面,食道入口部などが切除困難領域で,治療においては把持力の強い把持鉗子,視野展開には経鼻内視鏡を活用している.放射線照射後の救済治療例は潰瘍治癒が遅く,感染や後出血に注意が必要である.また,下咽頭〜食道入口部の広域切除例はステロイド局注による狭窄予防が必須である.
At TMDU, from August 1996 to May 2021, a total of 710 superficial pharyngeal cancers in 437 patients were treated with EMR(endoscopic mucosal resection)or ESD(endoscopic submucosal dissection)and ELPS(endoscopic laryngopharyngeal surgery). Since 2009, we have been performing ELPS in collaboration with head and neck surgeons.
Superficial cancers of ≤4cm, without muscle layer or cartilage infiltration, and without lymph node metastasis are treated at our institution. It is important to focus on aspiration pneumonia in patients with a history of head and neck cancer and postoperative cases of esophageal cancer. Areas that are difficult to treat include the base of the tongue, epiglottis valley, and orifice of the esophagus. Gripping forceps with strong gripping force are used, and a transnasal endoscope is used to obtain a good field of view. It is necessary to focus on infection and rebleeding in salvage cases after radiation therapy. Steroids are useful to prevent severe stenosis in cases of infiltration from the hypopharynx to the orifice of the esophagus.
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