食管黏膜下肿瘤超声内镜诊断及内镜治疗的临床研究  

Clinical study on the diagnosis of endoscopic ultrasonography and endoscopic treatment in patients with esophageal submucosal tumor

作　　者：武育卫[1] 彭贵勇[2] 何双丽 师雷峰 胡文华[1] 年影 徐美珍[1] 王仰坤[1] 

机构地区：[1]解放军第一五○中心医院消化内科,河南洛阳471031 [2] 第三军医大学西南医院全军消化病研究所

出　　处：《中国医师进修杂志》2016年第10期890-893,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：探讨超声内镜诊断食管黏膜下肿瘤的临床价值，以及内镜微创治疗食管黏膜下肿瘤的临床疗效。方法选取经普通胃镜和超声内镜诊断为来源于黏膜肌层和黏膜下层的食管黏膜下肿瘤患者68例，直径≤1.0 cm肿瘤行内镜下黏膜切除术（EMR），直径1.1～1.5 cm肿瘤行内镜下黏膜分片切除术（EPMR）或内镜黏膜下剥离术（ESD），直径＞1.5 cm肿瘤行ESD，术后标本行病理检查。结果68例患者均完全切除，病变直径0.6～2.3 cm，41例行EMR，9例行EPMR，18例行ESD。4例术中创面出血，经热活检钳电凝止血成功，无穿孔。术后病理：平滑肌瘤43例，间质瘤23例，脂肪瘤2例。术后3个月复查胃镜，所有患者创面形成白色瘢痕，无残留和复发，无食管狭窄。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，并可指导起源于黏膜肌层和黏膜下层的肿瘤行EMR、EPMR、ESD治疗，且内镜治疗安全、有效，可提供完整病理诊断资料。Objective To evaluate the diagnostic value of endoscopic ultrasonography （EUS）, and explore the efficacy of endoscopic treatment in patients with esophageal submucosal tumor. Methods Sixty-eight patients with esophageal submucosal tumor were selected, and the tumor was derived from the muscularis mucosa and submucosa according to the common endoscope and endoscopic ultrasonography detection. Endoscopic mucosal resection （EMR） was applied to remove submucosal tumor with diameter less than 1.0 cm, endoscopic piecemeal mucosal resection （EPMR） or endoscopic submucosal dissection （ESD） was applied to remove submucosal tumor with diameter 1.1 - 1.5 cm, and ESD was applied to remove submucosal tumor bigger than 1.5 cm. Samples were examined by pathology after treatment. Results Tumors in all the patients were completely removed, and the tumor diameter was 0.6-2.3 cm. Forty-one cases were treated with EMR, 9 cases were treated with EPMR and 18 cases were treated with ESD. Four patients had intra-operative bleeding that was stopped by electrocoagulation hemostasis. No perforation occurred in all cases. Postoperative pathology revealed 43 cases had leiomyoma, 23 cases had interstitialoma, and 2 cases had lipoma. Patients were reviewed by gastroscope 3 months after operation. The white scars formed in all patients, and there was no residue or recurrence. Conclusions Different origin layers and property of esophageal submucosal tumor can be diagnosed accurately by EUS, and endoscopic therapy （EMR, EPMR and ESD） is an effective treatment for submucosal tumor from muscularis mucosa and submucosa. Endoscopic therapy is safe and effective. It provides sufficient pathological information.

关 键 词：食管肿瘤 内镜下黏膜切除术 内镜黏膜下剥离术 超声内镜 

分 类 号：R735.1[医药卫生—肿瘤]