食管间质瘤的临床特点及内镜下治疗效果评价  

Clinical characteristics of esophageal gastrointestinal stromal tumors and outcomes of treatment under endoscope

作　　者：俞清翔[1] 郑忠青[1] 王涛[1] 王江[1] 何占坤[1] 王邦茂[1] 

机构地区：[1]天津医科大学总医院消化科,天津300052

出　　处：《上海交通大学学报（医学版）》2013年第5期636-639,666,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金青年基金(81000157)~~

摘　　要：目的探讨食管间质瘤的临床特点,评价内镜下治疗的效果和安全性。方法回顾性分析24例内镜下治疗后病理学确诊的食管间质瘤患者的临床资料,其中18例行内镜黏膜下剥离术(ESD),6例行内镜黏膜下隧道肿瘤切除术(STER),分析患者的基本情况、病变部位、超声内镜表现、组织学特征、治疗情况以及术后随访结果。结果 24例患者中,年龄>50岁者占70.83%,男性占70.83%;病变多位于食管下段,多起源于固有肌层;食管间质瘤伴平滑肌分化率高。18例行ESD患者中,肿瘤起源于黏膜肌层和固有肌层各9例,均一次性完整剥离,但1例固有肌层肿瘤剥离后发生0.3 cm穿孔。6例行STER患者的肿瘤起源于固有肌层,均一次性完整剥离。术后随访3～42个月未发现肿瘤残留和复发。结论内镜下治疗食管间质瘤安全、有效,对起源于固有肌层的食管间质瘤STER治疗优于ESD。Objective To investigate the clinical characteristics of esophageal gastrointestinal stromal tumors, and evaluate the safety and efficacy of treatment under endoscope. Methods The clinical data of 24 patients undergoing endoscopic treatment confirmed as esophageal gastrointestinal stromal tumors were analysed. Eighteen patients underwent endoscopic submucosal dissection （ESD）, and the other 6 received submucosal tunneling endoscopic resection （STER）. The demographic information, disease location, ultrasonic endoscopic presentation, histological features, treatment procedure and follow-up findings were analysed. Results Among the 24 patients, 70.83% aged no less than 50, and 70. g3% were males. The lesions mainly located in the lower part of esophagus, and mostly originated from the muscularis propria. The incidence of esophageal gastrointestinal stromal tumor with smooth muscle differentiation was high. Among the 18 patients undergoing ESD, the tumors originated from muscularis propria in 9 and from muscularis mucosa in the other 9, and all tumors were removed completely, while perforation of 0.3 cm occurred in one originating from muscularis propria. Among the 6 patients undergoing STER, all the tumors originated from muscularis propria, and were removed completely. Patients were followed up for 3 to 42 months, and no residue or recurrence of tumor was detected. Conclusion Endoscopic treatment is effective and safe in management of esophageal gastrointestinal stromal tumors, and STER is superior to ESD for those originating from the museularis propria.

关 键 词：食管间质瘤 内镜黏膜下剥离术 内镜黏膜下隧道肿瘤切除术 

分 类 号：R735.1[医药卫生—肿瘤]