内镜下治疗上消化道黏膜下肿瘤426例的临床观察  

Endoscopic management of upper gastrointestinal submucosal tumors: a retrospective review of 426 cases

作　　者：沈珊珊[1] 凌亭生[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《临床肿瘤学杂志》2014年第6期503-507,共5页Chinese Clinical Oncology

基　　金：国家青年自然科学基金资助项目(81201908)

摘　　要：目的观察经内镜治疗食管、胃和十二指肠的黏膜下肿瘤(SMT)的疗效和安全性以及术后病理组织学诊断情况。方法共入组426例上消化道SMT患者,其中位于食管346例,胃79例,十二指肠1例。经超声内镜诊断SMT位于黏膜肌层284例,黏膜下层87例,固有肌层55例。病变最大直径为0.4～6cm,平均(0.90±0.03)cm。426例SMT中333例行黏膜切除术(EMR),37例行黏膜剥离术(ESD),47例行黏膜挖除术(ESE),9例行全层切除术(EFR)。结果 EMR组中314例完整切除病变,完整切除率为94.3%。ESD组、EFR组均完整切除病灶,完整切除率100.0%。ESE组44例病灶完整切除,完整切除率93.6%(44/47),3例治疗失败转行外科手术。ESD组穿孔和出血各1例,发生率为2.7%;ESE组穿孔2例,出血2例,发生率为4.25%。EFR组为实现病灶完整切除,均将瘤体以及与之相连的固有肌层一并切除,实施主动穿孔,术后完全缝合胃壁缺损。术后病理组织学结果显示平滑肌瘤326例,间质瘤58例,异位胰腺、脂肪瘤、潴留囊肿、颗粒细胞瘤、血管机化、淋巴管瘤、血管瘤和神经鞘瘤共42例。患者术后均随访2年,无一例复发。结论经内镜治疗上消化道SMT安全、有效。Objective To evaluate the efficacy and safety of endoscopic resection for submucosal tumors（ SMT） of upper gastrointestinal tract and to analyze histological type of SMT. Methods Of 426 SMTs,346 located in esophagus,79 in stomach,1 in duodenum. By endoscopic ultrasonography（ EUS）,284 lesions were in muscularis mucosa,87 in submucosal layer,55 in muscularis propia. Lesions ranged from 0. 4cm to 6cm（ 0. 90 ± 0. 03cm）. Three hundred and thirty-three patients were managed by endoscopic mucosal resection（ EMR）,37 by endoscopic submucosal dissection（ ESD）,47 by endoscopic submucosal excavation（ ESE）,and 9 by endoscopic full-thickness resection（ EFR）. Results In EMR group,314 out of 333 lesions（ 94. 3%） were en bloc resected,compared with 100. 0% in ESD group and EFR group,and 44 out of 47 lesions（ 93. 6%） in ESE group. Three cases（ 2 complicated with unmanaged perforation,1 with maximum diameter reaching 6cm） from ESE group performed surgery for unsuccessful endoscopic resection. 1 case from ESD and ESE group each with delayed hemorrhage had endoscopic hemostatic therapy without surgery. Nine active perforation in EFR group were all successfully managed by endoscopy. Three hundred and twenty-six lesions were histopathologically diagnosed as leiomyoma,58 as gastrointestinal stromal tumors. No case relapsed in 2 years followed-up. Conclusion Endoscopic resection can be a safe and effective treatment for upper gastrointestinal tract SMT.

关 键 词：黏膜下肿瘤 内镜下黏膜切除术 内镜下黏膜剥离术 内镜下黏膜挖除术 内镜下消化道壁全层切除术 

分 类 号：R735[医药卫生—肿瘤]