上消化道粘膜下肿瘤的内镜诊断与微创手术治疗

Endoscopic diagnosis and minimal invasive surgery in submucosal tumors of the esophagus and stomach

目的 采用内镜下微创手术切除食管和胃粘膜下肿瘤，观察疗效及安全性。方法内镜诊断食管粘膜下肿瘤25例和胃粘膜下肿瘤8例，直径0．8～5．5cm。分别直接套切10例，粘膜切除15例，针状刀剥离切除5例，2例仅予以热活检，另1例转外科手术。切除标本行常规病理及免疫组化检查，术后定期内镜随访。结果 33例中30例（93．9％）内镜治疗均获得完全切除。术后3例发生创面出血，经钛夹成功止血，6例有轻度胸骨后疼痛，未发生其他并发症。病理报告食管平滑肌瘤18例，食管间质肿瘤7例，胃间质肿瘤8例。所有病例术后4周复查胃镜，并随访1～28个月不等，未见复发或远期并发症。结论 内镜微创手术切除小于2cm的食管或胃粘膜下肿瘤安全有效。

Objective To evaluate the effect of endoscopic diagnosis and treatment in submucosal tumors of the esophagus and stomach. Methods Esophageal submucosal tumors were diagnosed endoscopically in 25 cases and gastric submucosal tumors with 0. 8 to 5. 5 cm diameters in 8 cases. The tumors were resected by means of endoscopic ligation, electrosurgical snare or a needle knife. Results Of 33 tumors, 30 cases（93. 9% ） were resected completely by ligation or endoscopic mucosal resection. Except for 3 cases of treatable bleeding and 6 cases of post-operative substernal pain, no other complications were found. Pathological and immunohistochemical study showed that 18 cases were esophageal leiomyomas, 7 cases esophageal stromal tumors, and 8 cases gastric stromal tumors. No recurrence was found during the follow-up of 1-28 months. Conclusion Endoscopic minimally invasive operation is effective and safe for the treatment of submucosal tumors of the esophagus and stomach.