微探头内镜超声在食管黏膜下肿瘤内镜治疗中的应用

Application of miniprobe endoscopic ultrasonography in the endoscopic therapy of esophageal submucosal tumors

目的探讨微探头内镜超声(EUS)对食管黏膜下肿瘤(SMT)行内镜治疗的指导意义。方法食管SMT患者31例首先行微探头EUS检查判断病变的起源层次,然后采用高频电圈套器切除术、内镜黏膜切除术(EMR)以及囊肿穿刺术给予内镜下治疗。切除标本进行病理学及免疫组化检查。结果经微探头EUS诊断31例食管黏膜下肿瘤均起源于黏膜肌层或黏膜下层,其中平滑肌瘤或间质瘤27例,囊肿4例。27例平滑肌瘤及间质瘤中,21例采用高频电圈套器切除术,6例采用EMR方法切除;24例一次切除成功,3例加用热活检钳治疗。无穿孔并发症。4例囊肿中3例成功行内镜下穿刺治疗术,1例穿刺失败,改用高频圈套器切除术。内镜治疗取得26例标本,病理组织学结合免疫组化诊断为平滑肌瘤23例,间质瘤1例,恶性间质瘤1例,慢性黏膜炎症1例。病理与EUS诊断符合率为92.8%。结论微探头EUS对食管SMT有良好的判断价值,可以提高内镜治疗的安全性。

Objective To investigate the significance of miniprobe endoscopic ultrasonography （EUS） in the endoscopic therapy of esophageal submucosal tumor （SMT）. Methods 31 patients with esophageal submucosal tumors underwent miniprobe EUS examination for diagnosis of the layers of diseased tissues, followed by endoscopic treatments including high- frequency snare cauterization, endoscopic mucosal resection （EMR） and centesis of cyst. The postoperative specimens were performed for histopathological and immunohistochemical examinations. Results 31 cases of SMT diagnosed by miniprobe EUS were derived from muscularis mucosa or submucosa, of which 23 cases were leiomyomas or stromal tumors and 4 were cysts by EUS diagnosis. Of the 27 leiomyomas or stromal tumors, 21 cases were managed with snare cauterization and 6 with EMR. 24 cases were completely resected, and 3 cases were removed by additional method of hot biopsy forceps. There were no complications of esophageal perforation in all cases. Of the 4 cysts, 3 were successfully punctured by endoscopy but 1 was failure which was resected by snare cauterization instead. The specimens for endoscopic therapy were obtained in 26 patients. Histopathological and immunohistochemical examinations confirmed 23 cases of leiomyomas, 1 case of stromal tumor, 1 case of malignant stromal tumor, and 1 case of chronic mucosal inflammation. The coincidence rate of diagnosis between miniprobe EUS and pathology was 92.8%. Conclusion Miniprobe EUS is of considerable value in the diagnosis of esophageal SMT, and it can enhance the security of endoscopic therapy.