内镜黏膜下挖除术治疗食管固有肌层肿瘤

Endoscopic submucosal excavation of esophageal submucosal tumors originating from the muscularis propria layer

目的探讨内镜黏膜下挖除术（ESE）治疗食管固有肌层肿瘤的临床价值。方法回顾性分析2008年12月至2010年12月27例行ESE治疗的食管固有肌层肿瘤患者的资料，评价治疗的可行性、安全性和疗效。结果27例患者共29个病灶，病变直径0．5—3．0cm，平均（1．25±0．70）cm。切除率96．3％（26／27），1例患者中转手术治疗。中位手术时间74（30～120）min。术后病理诊断平滑肌瘤26例，间质瘤1例。2例术中穿孔伴气胸，金属夹夹闭创面后予胸腔闭式引流，未行开胸手术修补。中位随访时间12（3～27）个月，未见复发病例。结论对于直径小于3．0cm、腔内生长为主的食管固有肌层肿瘤，ESE治疗具有安全、有效的特点，并可提供完整的病理学诊断资料，进一步扩大了内镜治疗的范围。

Objective To study the value of endoscopic submueosal excavation （ESE） for esopha- geal submucosal tumors originating from the museularis propria layer. Methods Data of 27 patients with 29 lesions in esophageal muscularis propria treated with ESE from Dec. 2008 to Dec. 2010 were retrospected. Feasibility, effects and safety were evaluated accordingly. Results Of 27 patients, there were 17 males and 10 females. Mean age was 50 （22 - 62） yrs, and mean diameter of the lesions was 1.25 ± 0. 70 （0. 5 - 3.0） cm. Resection rate was 96. 3% （26/27）. One failed case with tumor residual after ESE received additional operation. The median procedure time was 74 （30-120） min. Pathological examination confirmed leiomyoma in 26 cases and gastrointestinal stromal tumor （GISTs） in 1 case. Perforation during operation occurred in 2 cases, accompanied with pneumothorax. They were treated with closed thoracic drainage, without surgery. The median follow-up time was 12 months （3 to 27 months）, and no recurrence was found. Conclusion ESE is a safe and effective therapy for the esophageal tumor smaller than 3.0 cm from the muscularis propfla.