内镜黏膜下剥离术治疗食管颗粒细胞瘤2例报告并文献复习  

Endoscopic submucosal dissection in treatment of esophageal granular cell tumor:A report of 2 cases and literature review

作　　者：周世平[1] 徐红[1] 王琇[1] 李蓥[1] 

机构地区：[1]吉林大学第一医院胃肠内科内镜中心,吉林长春130021

出　　处：《吉林大学学报（医学版）》2017年第5期1034-1036,I0006,共4页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅白求恩专项基金资助课题(20160101134JC)

摘　　要：目的:报道2例内镜黏膜下剥离术(ESD)治疗食管颗粒细胞瘤的病例,以提高对该病的临床认识。方法:回顾性分析2例患者的胃镜和超声胃镜结果,初步诊断为食管黏膜下隆起,遂行ESD完整切除肿瘤。首先标记病变边界,然后向黏膜下层注射透明质酸使病变充分隆起,沿标记点外缘将黏膜层环周切开,沿黏膜下层逐渐剥离病变至整块剥离,最后进行必要的止血及钛夹闭合创面。结果:术后病理显示,细胞呈多边形或梭形,胞质丰富且含有嗜双色性颗粒状物质,细胞核小;免疫组织化学显示,S-100(+),NSE(+)/(-),CK(-),SMA(-),CD117(-),desmin(-),证实为食管颗粒细胞瘤,患者术后顺利恢复,术后16个月复查,2例患者均无局部复发及转移。结论:ESD是一种治疗食管颗粒细胞瘤安全有效的方法,患者术后预后良好。Objective：To report two cases of esophageal granular cell tumor treated by endoscopic submucosal dissection,and to improve the clinical awareness of the disease.Methods： The results of endoscope and ultrasonography endoscope of 2cases were retrospectively analyzed.A preliminary diagnosis of the 2 cases was esophageal submucosal protruded lesion.The patients underwent endoscopic submucosal dissection and the tumors were removed completely.Firstly,the lesion border was marked and then hyaluronic acid was injected into submucosa to uplift the lesion sufficiently.Secondly,the mucosa was circumferentially incised along the marked points,and then the lesion was dissected along the submucosal layer gradually to the whole.Finally,necessary hemostatic was undertaken and the wound was clipped with titanium.Results：The pathological results after operation represented that the cells were polygonal or fusiform,rich in cytoplasm and had a dichromatic granular substance,and the nuclei were small.The immunohistochemical results showed S-100（＋）,NSE（＋）/（-）,CK（-）,SMA（-）,CD117（-）,desmin（-）and proved that 2 cases of tumors were esophageal granular cell tumor.Two patients recovered smoothly after operation.They underwent endoscopic examination 16 months after operation,and no local recurrence or metastasis was founded.Conclusion：Endoscopic submucosal dissection is a safe and effective treatment of esophageal granular cell tumor,and the postoperative prognosis is good.

关 键 词：食管颗粒细胞瘤 超声胃镜 免疫组织化学 内镜下黏膜切除术 内镜黏膜下剥离术 

分 类 号：R735.1[医药卫生—肿瘤]