食管间叶源性肿瘤的内镜下切除

Endoscopic resection of esophageal mesenchymal tumors

目的探讨内镜下切除食管间叶源性肿瘤的方法,并对其疗效和安全性进行分析。方法对39例食管间叶源性肿瘤进行内镜下切除:超声内镜显示起源于黏膜肌层且直径小于1.0cm的肿瘤进行圈套器高频电切除,对起源于黏膜肌层但直径大于1.0cm或病变扁平圈套切除困难的肿瘤、固有肌层的肿瘤行内镜黏膜下剥离术。结果完全切除率:起源于黏膜肌层的28例肿瘤,均一次性完整切除,完全切除率100%,起源于固有肌层的11例肿瘤,1例术中出血较多,内镜下止血无效转外科手术,2例与肌层粘连紧密无法切除,完全切除率72.7%,两组完全切除率比较,差异有统计学意义(P<0.05)。并发症:起源于黏膜肌层的28例肿瘤,出血1例,无穿孔,并发症的发生率为3.5%,起源于固有肌层的11例肿瘤,出血2例,穿孔2例,并发症的发生率增加为:36.3%。两组并发症比较,差异有统计学意义。结论内镜下可安全有效地切除起源于黏膜肌层的食管间叶源性肿瘤,对于起源于固有肌层的食管间叶源性肿瘤,完全切除率下降,出现穿孔、出血等并发症的几率明显增加,应外科手术治疗。

Objective To explore the methods of endoscopic dissection of esophageal mesenchymal tumors and to evaluate their safety and efficiency for the treatment of esophageal mesenchymal tumors.Methods Endoscopic electro-section or sub-mucosal dissection was performed in 39 cases of esophageal mesenchymal tumors.Tumors which originated from mucosal muscularis determined by endoscopic ultrasonography（EUS） and were less than 1.0cm in diameter were resected by snare electro-section.Tumors which originated from mucosal muscularis and were more than 1.0cm in diameter,which were too flat to snare,or which originated from muscularis propria determined by EUS were resected by endoscopic sub-mucosal dissection（ESD）.Results Complete resection rate： tumors originating from mucosal muscularis in all the 28 cases were completely resected.In the 11 cases whose tumors originated from muscularis propria,much bleeding was not successfully controlled by endoscopy and was then treated by surgery in 1,the tumor adhered to the muscularis propria and was not resected by the endoscopy in 2,and the complete resection rate was 72.7%.There was a significant difference in complete resection rate between the two groups（P0.05）.Complications 1 case had bleeding and none had perforation in the 28 cases whose tumors originated from mucosal muscularis,and the complication rate was 3.5%;2 cases had bleeding and 2 cases had perforation in 11cases whose tumors originated from muscularis propria,and the complication rate was 36.3%.There was a significant difference in complication rate between the two groups（P0.05）.Conclusion It is safe and effective to conduct endoscopic resection for esophageal mesenchymal tumors originating from mucosal muscularis.For tumors originating from muscularis propria,the complete resection rate decreases and the complication rate increases,and they should be treated by surgery.