食管黏膜下肿瘤的超声内镜诊断与内镜下微创治疗  

Endoscopic ultrasonography in diagnosis and minimally invasive treatment of esophageal submucosal tumors

作　　者：张蓉[1] 李传行[1] 高小燕[1] 罗广裕[1] 林世永[1] 李茵[1] 徐国良[1] 

机构地区：[1]华南肿瘤学国家重点实验室(中山大学肿瘤防治中心)内镜科,广东广州510060

出　　处：《中国内镜杂志》2010年第1期21-24,共4页China Journal of Endoscopy

摘　　要：目的评价超声内镜对食管黏膜下肿瘤的诊断及治疗价值,探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管黏膜下肿瘤的疗效和安全性。方法对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查。2例起源于黏膜层的食管息肉;34例起源于黏膜肌层的食管平滑肌瘤;4例起源于黏膜下层,包括脂肪瘤2例,食管囊肿1例,孤立静脉瘤1例(内镜下呈蓝紫色,未予处理)。根据食管黏膜下肿瘤的起源层次、性质及病变大小决定行内镜下EMR或ESD治疗,完整切除病变。结果40例食管黏膜下肿瘤,病变最大直径0.4～2.5cm,平均1.45cm。29例行内镜下EMR治疗,6例病变最大直径超过1.5cm者行内镜下ESD治疗,ESD手术时间15～45min,平均30min。4例起源于固有肌层的食管黏膜下肿瘤考虑穿孔可能性大未予内镜下治疗。2例术中出血较多,经内镜下喷洒止血药物、电凝、氩离子凝固术治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔。所有EMR、ESD切除病变全部送检病理确诊,基底和切缘未见病变累及。术后1.5及6个月随访,创面愈合,无病变残留和复发。结论超声内镜能够对食管黏膜下肿瘤进行起源和定性诊断,可指导黏膜下肿瘤的治疗。大多数食管黏膜下肿瘤行EMR治疗简便、安全,对于病灶较大、EMR难以完整切除的病变行ESD治疗安全、有效,可以完整切除食管病变,提供完整的病理诊断资料。[ Objective ] To evaluate the diagnostic value of Endoscopic ultrasonography （EUS） and endoscopic therapies in esophageal submucosal tumors under the guidance of EUS. To assess the clinical efficacy and safety of endoscopic mucosal resection （EMIl） and endoscopic submucosal dissection （ESD） for submucosal tmnor （SMT） of the esophagus. [ Methods ] A total of 40 patients with SMT of the esophageal diagnosed by endoscopy were examined using EUS. 2 esophageal polypus derived from mucosa. 34 esophageal leiomyoma from muscularis mucosa, 4 from submucosa： included 2 lipomas, 1 oesophagus cyst, 1 vein tumor （no therapy）. EMR or ESD had been taken accord- ing to the different deriving layers, histology and size. Then, the lesion was resected completely. [ Results ] The re- seeted lesions sized 0.4-2.5 em in diameter （mean, 1.45 em）. Among the 40 lesions, 29 were successfully resected with EMR. The resected lesions sized over 1.5 cm in diameter, 6 cases were successfully resected with ESD. The mean ESD procedure time was 30 rain （ranged from 15 to 45 min）. 4 SMTs from proper nmscle layer were not re- sected with endoscopic therapy to avoid perforation. Two patients had massive hemorrhage during ESD, which could be controlled under a gastroseope. None of the patients had delayed bleeding after ESD. Perforation had not occurred in ESD. Histological evaluation showed that the tunica of the tumors was intact, and both the lateral and basal mar- gins of the specimens were free of tumor cells. Followed up in 1.5 and 6 months after ESD, with confirmed healing of the artificial ulcer with no residue or recurrence. [ Conclusions ] Different layers of esophageal submucosal tumors can be distinguished clearly by EUS, leading to definite diagnosis of submucosal tumors. EUS is important in select- ing treatment procedures of SMT and should routinely be performed on all presumptive submucosal tumors prior to attempt at removal. Most of SMTs are resected simply and safety by EMR. If the lesions wasnot reseet

关 键 词：超声内镜 内镜黏膜切除术 内镜黏膜下剥离术 食管黏膜下肿瘤 

分 类 号：R735.1[医药卫生—肿瘤]