内镜在胃肠道神经鞘瘤中的诊治价值探讨  

Endoscopic diagnosis and management for gastrointestinal schwannoma

作　　者：蔡明琰[1] 姚礼庆[1] 周平红[1] 徐美东[1] 钟芸诗[1] 张轶群[1] 马丽黎[1] 陈巍峰[1] 秦文政[1] 胡健卫[1] 李全林[1] 

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2012年第5期259-262,共4页Chinese Journal of Digestive Endoscopy

基　　金：上海市科委医学引导类计划项目（10411969600）

摘　　要：目的探讨胃肠道神经鞘瘤的内镜诊断及内镜治疗价值。方法回顾性分析2006年1月至2011年7月间接受内镜下检查并获得病理确诊的胃肠道神经鞘瘤13例临床资料。结果13例患者病变，8例位于胃，3例位于食管，2例位于结肠。超声内镜检查发现神经鞘瘤位于固有肌层，超声表现主要为低回声。12例接受内镜下治疗，11例患者在内镜下成功接受治疗，完整切除肿瘤，完整切除率为（91．7％）。其中6例行内镜黏膜下挖除术治疗，4例行内镜全层切除术治疗，1例食管神经鞘瘤行内镜经黏膜下隧道切除术治疗。1例食管病变由于肿瘤巨大（肿瘤最大径4．7cm），内镜部分切除病灶后，基底部仍较深，无法完整切除，终止内镜手术，转胸外科手术治疗。所有病例术后未出现胃肠道出血、腹膜炎体征和腹腔脓肿等并发症。平均随访时间（23．3±10．8）个月（6～36个月），在随访过程中未发现肿瘤复发或转移。结论内镜及超声内镜有助于辅助诊断胃肠道神经鞘瘤并提供治疗指导，内镜下治疗胃肠道神经鞘瘤是安全、有效的。Objective To study the diagnostic and therapeutic value of endoscopy for gastrointestinal （GI） schwannoma. Methods We retrospectively studied data of 13 patients who underwent endoscopy and were confirmed as having GI schwannoma by pathology in our hospital during January 2006 and July 2011. Results Schwannoma of 8 patients located in stomach, 3 in esophagus and 2 in colon. Endoscopic ultrasonography showed schwannoma originated from muscularis propria, characterized by hypoecho. Twelve patients received endoscopic treatment, and 11 were suecessfully removed. The en bloc resection rate was 91.7%. Among them, 6 were treated by endoscopic submueosal excavation, 4 by endoscopic full-thickness resection and one by submueosal tunnel endoscopic resection. Another patient with sehwannoma located in esophagus with a maximum diameter of 4. 7 cm was transferred to thoracic surgery since the tumor had a wide base even after partial resection. No bleeding, inflammation or abscess occurred. The average follow-up time was 23.3 ＋ 10. 8 months （ range, 6-36 months）. No metastasis or recurrence was found during follow-up. Conclusion Endoscopy and endoscopic uhrasonography, safe and efficacious, are valuable for the diagnosis and treatment of GI schwannoma.

关 键 词：神经鞘瘤 内窥镜检查 胃肠道 诊断 治疗 

分 类 号：R735.2[医药卫生—肿瘤]