内镜黏膜下剥离术治疗消化道巨大脂肪瘤

Endoscopic submucosal dissection in the treatment of giant gastrointestinal lipomas

目的探讨内镜黏膜下剥离术（EsD）治疗消化道巨大脂肪瘤的疗效和安全性。方法回顾性分析2007年8月至2010年8月上海复旦大学附属中山医院内镜中心采用ESD方法切除的32例消化道巨大脂肪瘤患者的临床资料。32例脂肪瘤中位于食管1例、胃6例、十二指肠2例、回盲瓣7例、结肠15例、直肠1例。术前超声内镜诊断准确率为93．8％（30／32）。肿瘤最大径为3．o至8．0cm，平均4．2cm。结果32例脂肪瘤均在内镜下成功剥除，成功率为100％（32／32）。ESD手术时间为25至110min，平均37min。术中平均出血量约40m1，未出现穿孔和术后出血。术后病理检查均证实为脂肪瘤。随访率为90．6％（29／32），随访时间为6至36个月，无复发。结论ESD治疗消化道巨大脂肪瘤安全、有效，可临床推广应用。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） in the treatment of giant gastrointestinal lipomas. Methods From August 2007 to August 2010, the clinical data of 32 patients with giant gastrointestinal lipomas treated by ESD at Endoscopy Center, Zbongshan Hospital Fudan University were retrospectively analyzed. Among 32 cases of giant gastrointestinal lipomas one case was in esophagus, six cases in stomach, two cases in duodenum, seven cases in ileocecal valve, 15 cases in colon and one case in rectum. Preoperative diagnostic accuracy of endoscopic ultrasonography （EUS） was 93.8 % （30/32）. The maximum diameter of tumor ranged from 3.0 cm to 8.0 cm （average 4. 2 cm）. Results All tumors were successfully dissected under endoscopy. The success rate was 100% （32/32）. The operation time was between 25 minutes and 110 minutes （average 37 minutes）. The average intraoperative blood loss was 40 ml, and no perforation and delayed bleeding was found after ESD. All were proved to be lipomas by histopaphology after operation. The rate of follow-up was 90.6% （29/32）. The follow-up time was from six to 36 months. Conclusion ESD is a safe and effective method for the treatment of giant gastrointestinal lipomas, which can be applied extensively in clinical.