超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤的手术疗效  

Endoscopic ultrasonography improving the operation effect for detecting precisely the origin and histology characteristics of esophageal leiomyoma

作　　者：谭学明[1] 赵冉 孙永珍 高晓炎 招鹏 王燕[1] 朱敏 李卫东[1] TAN Xue-ming;ZHAO Ran;SUN Yong-zhen;GAO Xiao-yan;ZHAO Peng;WANG Yan;ZHU Min;LI Wei-dong(Department of Gastroenterology,Southeast University Affiliated Nanjing Zhongda Hospital Jiangbei Wards,Nanjing 210044,China)

机构地区：[1]东南大学附属中大医院江北院区(南京市大厂医院)消化内科,南京210044

出　　处：《解剖学报》2021年第6期966-971,共6页Acta Anatomica Sinica

基　　金：南京市卫生发展专项资金(YKK20187)。

摘　　要：目的探讨超声内镜评估肿瘤起源及组织学特征能否提高内镜下切除食管平滑肌瘤的手术疗效。方法回顾性分析2016年1月~2020年6月因食管黏膜下肿瘤于消化内科治疗并经病理证实为平滑肌瘤患者的临床资料。共58例食管平滑肌瘤患者接受术前超声内镜检查评估后进行内镜下切除。统计患者的肿瘤完整切除率、手术时间、住院时长及并发症发生情况。结果术前超声内镜提示,平滑肌瘤起源于黏膜肌层39例,固有肌层19例。瘤体平均直径1.50(0.2~6.5) cm,其中20例行内镜黏膜切除术(EMR),32例行内镜黏膜下挖除术(ESE),6例行黏膜下隧道内镜肿瘤切除术(STER)。总体完整切除率为96.6%。平均手术时间为38.29(15~100) min。术后并发症发生率15.5%(9/58),均经保守治疗后好转。在39例黏膜肌层起源平滑肌瘤中,20例行EMR,19例行ESE,两组患者的肿瘤大小及并发症发生上差异不显著,但EMR组的手术时间及患者术后住院天数明显更短(P<0.05)。在19例固有肌层起源平滑肌瘤中,13例行ESE,6例行STER,两组患者在肿瘤大小、手术时间、术后住院天数及并发症发生上差异均无显著统计学意义。结论术前超声内镜精准评估肿瘤起源及组织学特征可提高食管平滑肌瘤手术疗效。Objective To investigate whether assessment of the tumor origin and histological features through endoscopic ultrasonography could improve the operative efficacy of endoscopic resection of esophageal leiomyoma. Methods The clinical data of patients with esophageal submucosal tumor who were treated in our department and diagnosed as leiomyoma pathologically from January 2016 to June 2020 was retrospectively analyzed. A total of 58 patients with esophageal leiomyoma underwent endoscopic resection following evaluation of endoscopic ultrasonography. The en bloc resection rate,operation time,hospitalization day,and complications were evaluated. Results Preoperative endoscopic ultrasonography showed that leiomyoma originated from muscularis mucosa in 39 cases and muscularis propria in 19 cases.The mean tumor size was 1. 50( 0. 2-6. 5) cm,and 20 cases underwent endoscopic mucosal resection( EMR),32 cases underwent endoscopic submucosal excavation( ESE),and 6 cases underwent submucosal tunneling endoscopic resection( STER). The overall en bloc rate was 96. 6%. The mean operation time was 38. 29( 15-100) min. The postoperative complication rate was 15. 5%( 9/58),and all were recovered after conservative treatment. Among the 39 cases originated from the muscularis mucosa,20 cases underwent EMR and 19 cases underwent ESE. There were no significant differences in tumor size and complications between the two groups, but the operative time and the length of postoperative hospitalization in the EMR group were significantly shorter( P < 0. 05). Among the 19 patients originated from the muscularis propria,13 cases underwent ESE and 6 cases underwent STER. There were no significant differences in tumor size,operative time,the length of postoperative hospitalization and complications between the two groups. Conclusion Preoperastive endoscopic ultrasonography could precisely detect the origin and histology characteristics of esophageal leiomyoma and improves the operation effect.

关 键 词：黏膜下肿瘤 起源 超声内镜 食管平滑肌瘤 内镜下切除术 人 

分 类 号：R615[医药卫生—外科学]