外套管辅助内镜下黏膜切除术在治疗食管上段胃黏膜异位症中的价值探讨

Wrapper tube assisted endoscopic mucosal resection for upper esophageal mucosal endometriosis

目的探讨外套管辅助内镜直视下黏膜切除术治疗食管上段胃黏膜异位症的临床价值。方法选择经内镜检查和病理证实为食管上段胃黏膜异位症并伴有局部症状的患者53例进行内镜治疗，将外套管套在内镜外，随内镜一起插入患者食管内，将内镜退至外套管内，边退外套管边观察，见外套管头部刚好退至病变部位口侧，固定外套管，行内镜下黏膜切除术。术后随访观察疗效。结果53例患者采用一次性切除者45例，2次切除者5例，3次切除者3例。平均每例所需时间为6．5min（4．5～7．5min），内镜下完全切除率达100％。术后3个月随访时43例症状消失，占81.1％：6个月随访时45例症状消失，占85％。内镜及活检病理均未见复发。无食管狭窄、穿孔及心肺意外等并发症。结论食管上段胃黏膜异位症合并局部症状者，采用外套管辅助固定内镜直视下黏膜切除具有手术简便、仓Ⅱ伤小、恢复快、疗效确切的特点。

Objective To Investigate the safety and clinical significance of self-made wrapper tube assisted endoscopic mucosal resection for upper esophageal mucosal endometriosis. Methods A total of 53 patients with upper esophageal mucosal endometriosis and the corresponding symptoms, which was confirmed by endoscopy and pathology, underwent endoscopic treatment. The endoscope was inserted into the esopha- gus together with wrapper tube. Then the endoscope was retreated into the wrapper tube and pulled back together with the tube. When the tip of the wrapper tube reached at the oral side of the lesion, it was fixed, and submucosal resection was performed. All patients were followed up to 6 months. Results All lesions were completely resected, which was achieved by one session in 45 patients, by two in 5, and by three in 3 other patients, with a mean procedure time at 6. 5 minutes （4. 5-7. 5）. Symptoms were relieved in 43 patients （81.1%） at 3 months after the procedure, and in 45 patients （85%） at 6 months. No local recurrence was observed under endoscopy and biopsy. No complications including esophageal stenosis, perforation or cardiopulmonary accidence were recorded. Conclusion For upper esophageal mucosal endometriosis presented with local symptoms, wrapper tube assisted endoscopic mucosal resection is safe, less invasive, easy to manipulate and effective.