食管粘膜下肿瘤的内镜下切除术

Endoscopic resection of esophageal submucosal tumors

目的探讨消化内镜下切除食管粘膜下肿瘤的方法,并依据临床病理及免疫组织化学表型确定其诊断。方法自2003～2007年我们对38例食管粘膜下肿瘤进行了内镜下切除,对位于粘膜肌层的肿瘤进行圈套电切或电铲除的方法切除,对超声胃镜确定位于固有肌层的肿瘤做内镜下粘膜下层剥离术(ESD)切除,并对切下的标本进行临床病理学检查和免疫组织化学分析,通过连续切片进行CD34、CD117、Vimentin、Desmin染色方法观察免疫组织化学表型,术后3个月随访胃镜检查。结果位于粘膜肌层的26例肿瘤,平均直径为15mm(10～35mm),均一次性完整切除,平均手术时间7min(3～31min);位于固有肌层的12例肿瘤,平均直径为20mm(12～32mm),均一次性完整切除,平均手术时间110min(96～145min),其中1例术后3个月复发,进行第二次ESD手术。免疫组化结果:本组38例CD34为100%阴性,CD117为100%阴性,Vimentin为81.6%阴性;Desmin为100%阳性(++～+++),均确定为平滑肌瘤。结论消化内镜下可安全有效地进行食管粘膜下肿瘤切除术,包括源于固有肌层的平滑肌瘤。

Objective To explore the methods of endoscopic electrosection of esophageal submucosal tttmors and make diagnosis based on clinicopathological and immunohistoehemical staining. Methods From 2003 -2007, endoscopic electrosection or submucosal dissection of 38 cases of esophageal submucosal tumors were performed. The tumors originated from mucosal muscularis were resected by snare electrosection or shovel electrosection , the tumors originated from muscularis propria determined by endoscopic ultrasonography were resected by endoscopic submucosal dissection （ESD）. The specimen resected were examined clinieopathologieally and immunohistoehemieally. CD34, CD117, Vimentin, Desmin staining technique in paraffin - embedded tissue were used and observed by immunohistoehemical phenotype. Gastroscopic examinaion was followed up 3 months after operation. Results The tumors in 26 cases originated from mucosal muscularis with a mean diameter of 15mm （10 - 35mm）, were all resected en bloc, mean operation time was 7 minutes （3 -31 minutes） ; tumors in 12 cases originated from muscularis propria and with a mean diameter of 20mm （16 -35mm） were all resected en bloc and the mean operaion time was 110 minutes （96 - 145minutes）. One case was recurrent 3 months after operation,and treated with ESD operation. The immunohistochemical results showed that CD34 and CDll7 of 38 cases were all negative,Vimentin 81.6% negative , Desmin 100% positive （＋ ＋ - ＋ ＋ ＋ ） ,Thus they were all diagnosed as leiomyoma. Conclusion It is safe and effective to conduct endoscopic electrosection of esophageal submucosal tumors , included leiomyoma originated from muscularis propria.